Two of the study sites go beyond informal communication among staff or even the sharing of information through staffings. In the IRIS Program in Minneapolis, MN and in Arlington, VA, staff operate as a team. In these sites, information is shared on an on-going basis and supported by an understanding of joint responsibility for a case.
The IRIS Program is designed to assist welfare recipients who have trouble fulfilling their Minnesota Family Investment Program (MFIP) employment plan requirements due to a mental or chemical health problem. IRIS takes a multi-disciplinary approach to these issues by assigning each client to a team of specialists. Each team consists of a social worker, a vocational counselor, and a therapist. When it was originally designed, the IRIS Program used a single staff person—a vocational counselor—to work with clients to address their unobserved barriers to employment. However, approximately eight months into the implementation of IRIS, staff realized that clients faced a complex array of issues that require more support than a vocational counselor alone could provide. In response to this need, the IRIS Program sought and obtained additional funding to create a team staffing structure that includes social worker and therapist in additional to the vocational counselor.34
The IRIS staffing structure assigns staff in teams with relatively small caseloads—each vocational counselor carries a caseload of 20 and works with two social workers who carry caseloads of ten each.35 The team works with the client to develop an individualized plan that will assist the client in overcoming social and employment-related barriers. IRIS team members reported regular, on-going interaction among team members. Social workers and vocational counselors conduct a joint assessment which provides both members of the team critical information regarding the client’s situation. Additionally, social workers meet with the vocational counselor throughout the initial period of social stabilization (prior to involvement in vocational services) to keep the vocational counselor apprised of progress and additional issues that arise. Finally, the therapist also communicates with the social worker and vocational counselor, sharing (as appropriate) information from her sessions with clients.
IRIS team members provided positive feedback regarding this team structure. The team approach reportedly allows each staff member to focus on a more narrow range of issues drawing on his or her own area of expertise while providing a comprehensive set of services to meet clients’ needs. There appeared to be little confusion regarding roles or information sharing, and staff reported appreciating the contribution made by other members of the team. All members of the IRIS team were committed to working with the client to identify and address her needs through a supportive and caring approach. They also collectively believed that there was no client need that the team, individually or collectively, could not address.
In Arlington, VA, team members work with a specified group of clients and work together closely to ensure that the client is fulfilling participation requirements and obtaining necessary services.
Arlington, Virginia also utilizes a team approach to coordinate the efforts of the various types of staff who may be involved in an individual client’s case. At the time of welfare reform, Arlington recognized the need for linking the work done by eligibility workers with that done by the staff known at the time as JOBS workers. While other counties in Virginia decided to assign both eligibility and employment program duties to eligibility workers, officials in Arlington believed that eligibility workers already had multiple programs to learn and administer and would not be able to manage the additional responsibility of the employment services required by TANF. Instead, they chose to create a team consisting of the ongoing financial eligibility worker, the TANF employment case manager, the job developer, and the Crisis Assistance Bureau social worker. The latter is not as intensively involved compared to the other member of the team, unless the client has been referred to the social worker for help with immediate needs.36 A substance abuse/mental health therapist, a co-located partner, would be a member of the team if a client had been specifically referred to him or her or if other team members were unsure of the specific barriers that were preventing clients from getting or keeping jobs and wished to draw on the therapist’s expertise.
Team members work with a specified group of clients and work together closely to ensure that the client is fulfilling participation requirements and obtaining necessary services. In addition to frequent, on-going communication among the members of the core team (who are housed in the same physical location), the team meets monthly to discuss issues, problems, and concerns related to specific cases facing crucial needs (e.g., nearing the end of the time limit or encountering a crisis that might cause them to lose their job). Individual case staffings can also be convened and may include team members, staff from relevant partner providers, and clients themselves.
If a client is referred to the Vocational Rehabilitation program operated by the Department of Rehabilitation Services (DRS), a second team is formed. In such a situation, the team consists of the DRS employment counselor, staff from Sheltered Occupational Center (SOC) Enterprises and a psychologist. These team members coordinate with each other to complete additional evaluations and/or provide diagnoses, develop an employment plan, and secure appropriate services or accommodations for the client. The second team also meets with members of the core team, (usually the TANF employment case manager and the job developer), thus linking the members of the two teams, all of whom work together to address the needs of the client.
Team members in Arlington were, in general, very positive about the team approach to case management and service provision that had been implemented. Staff believed that the team approach was particularly helpful in providing multiple opportunities for different types of staff to develop a relationship with and identify barriers faced by individual clients. For example, a job developer in the course of weekly job search meetings with the participant, might identify a potential barrier that the case manager had missed. The two workers would immediately consult with each other, and other team members as appropriate, to discuss the situation and make necessary referrals. Staff reported that the physical co-location of the primary team members, as well as the regular presence of the substance abuse/ mental health therapist and staff from DRS and SOC Enterprises, contributed to the successful operation of the team concept.
34 Prior to this professional mental health services were purchased from outside agencies. It was noted that bringing this service in-house provided more immediate access to psychological services necessary to meet clients’ needs.
35 Therapists work with varying numbers of clients depending on clients’ need for on-going therapy.
36 Crisis Assistance Bureau Social Workers are social workers with Masters-level degrees and at least two of years of relevant experience who assist clients with emergency needs such as shelter, utility bills or food assistance. In the course of addressing these emergency needs, unobserved barriers may be identified.