Providing Mental Health Services to TANF Recipients: Program Design Choices and Implementation Challenges in Four States. Tennessee's Family Services Counseling Program


Program origins. In 1999, the director of Families First Services(22) initiated an assessment of the types and prevalence of work barriers among TANF recipients. Based on local welfare administrators' reports, Tennessee's Department of Human Services (DHS) determined that a portion of families on cash assistance needed more intensive clinical case management and counseling services. This prompted the creation of a statewide program, Family Services Counseling (FSC), to assist families with barriers to move from welfare to work. DHS contracted with the College of Social Work at the University of Tennessee (UT) for the administration of the FSC program. In January 2000, UT hired a director to design and implement the FSC program. Family services counselors began receiving referrals in February 2000.

Scope of barriers targeted. The FSC program targets TANF customers and family members with mental health conditions, learning disabilities, or substance abuse, domestic violence, or child behavioral problems, but will also provide services to families with other types of challenges, such as parenting difficulties and homelessness.

Eligibility for mental health services. Services are available to all family members on the TANF case. Families may receive FSC services while on cash assistance and up to 12 months after case closure.

Strategies for identifying customers with mental health conditions. Tennessee uses a multifaceted approach to identify and connect customers to the FSC program.

  • Orientation. TANF clients first are made aware of the FSC program at their group orientations. During orientation, a family services counselor explains the FSC program and provides an outline of the types of services offered and how to access these services.
  • Case Managers. TANF clients are commonly referred to the FSC program by DHS case workers. During the development of a customer's personal responsibility plan, the case worker may recommend FSC services. The DHS case workers are educated about the FSC program, and they are trained to identify substance abuse problems, mental health conditions, and domestic violence.
  • Referrals by Employment Service Providers or Community Agencies. The local contracted employment and education agencies are informed about FSC services. They may refer customers to the program through the DHS case worker or directly to a family services counselor.
  • Mandatory Referrals. DHS case workers are mandated to offer referrals to sanctioned clients. Sanctioned clients who chose FSC as an activity to remedy a sanction are required to meet with family services counselors during the two-week compliance period before they can begin receiving cash assistance again.
  • Community Outreach. The FSC program has a widespread social marketing effort. Presentation and training sessions for DHS staff and other community partners help educate workers statewide about the FSC program mission, goals, and success. Some areas have outlocated family services counselors to inform clients about the FSC program. In Chattanooga, for example, there is a family services counselor located at the Harriet Tubman Housing project.

Types of mental health services provided. There is a range of mental health services available to customers in the FSC program. They are described below.

  • Standardized Assessment. All customers receive a statewide standardized assessment with a family services counselor to determine the appropriate treatment for the client.
  • Solution-Focused Therapy. Family services counselors provide solution-focused therapy to their clients. Family services counselors receive extensive training on using a solution-focused brief therapy approach, which identifies and uses client strengths and resources to identify and solve problems.
  • Linkage with Local Mental Health Providers. Customers that require intensive long-term treatment or medication management are referred to mental health centers accepting TennCare.(23) Family services counselors also refer customers with learning disabilities or domestic violence, substance abuse, and child behavioral problems to other agencies for assessment and treatment.
  • Intensive Case Management. The family services counselors provide customers with individualized assistance to address barriers to self sufficiency. Family services counselors may assist customers with supportive services such as housing and transportation.
  • Consultation with DHS Case Workers. The family services counselors make recommendations to DHS case workers for modified work plans based on their work with clients. Because family services counselors are co-located in the local welfare offices, DHS case workers frequently consult with them about difficult cases and most family services counselors provide training for DHS staff to identify barriers to work among clients.
  • Assistance with Applying for SSI. The family services counselors help to coordinate psychological evaluations and walk customers through the Supplemental Security Income application process.

The relationship between mental health services and work requirements. While the Families First program emphasizes employment, it allows customers to participate in other activities such as mental health treatment, education, or training before going to work. Customers referred to the FSC program are not required to participate in self-sufficiency activities until a family services counselor has assessed them. The month of the client's assessment does not count against their time limit for receiving cash assistance, and a family services counselor may request a time limit interruption for clients with severe mental health conditions. There is a broad range of activities that may be included in the client's self-sufficiency plan, including mental health treatment. Most customers participating in the FSC program blend work activities, such as life skills workshops, with mental health treatment. The goal is to gradually move customers into work, but work is not required as a first activity.

Administrative structure. Staff members for the FSC program are hired through UT and local contracted service providers. The FSC program director and district coordinators are university employees. Within each district, DHS contracts with local not-for-profit agencies to provide family service counselors and clinical supervision. In some of the sites, the local agencies had formed collaborative relationships prior to the FSC program. These relationships were instrumental in implementing the FSC program in these areas. For example, DHS contracted with Family and Children's Services of Greater Chattanooga (FCS) to provide family services counselors for Hamilton County because they have been administering programs such as life skills training, parenting classes, employee assistance programs, and outpatient mental health treatment for over 120 years.

When customers need services, in addition to family services counseling, they are referred to the TennCare mental health providers. The types of agencies providing treatment vary across the state. For example, the urban area of Hamilton County has a variety of treatment providers including a residential and an outpatient substance abuse treatment center, while rural Montgomery County is more limited, with one mental health center and several not-for-profit agencies that provide primarily group treatment to low-income families.

Funding mental health services. The operating budget for the FSC program is approximately $8 million. Most of the money allocated is used to contract with UT for program administration and with local not-for-profit agencies to hire family services counselors. Most TANF families can access mental health treatment through their TennCare assistance. Families who leave cash assistance generally qualify for transitional TennCare benefits, which cover mental health treatment.

For additional information please contact:

Holly Cook
Program Director Families Services Counseling Program
University of Tennessee
Phone: (615) 313-5465

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