Yet another reason why TANF agencies who are not already doing so should consider screening and assessing is the prevalence of disabilities and barriers to employment among TANF recipients. A review of several studies with prevalence estimates for substance abuse, learning disabilities, domestic violence, and mental health problems, describe high rates of incidence - a compelling reason for states to enhance or adopt screening and assessment efforts.
Prevalence of Multiple/Co-Occurring Barriers. Many TANF clients face multiple (co-occurring) barriers to employment with some barriers more likely to co-occur than others. Several studies estimate the prevalence of multiple barriers to employment among welfare recipients. Although estimates vary, in part due to differences in definitions of barriers to work, estimates of the co-occurrence are still useful. In a review of several studies, Johnson and Meckstroth (1998) report that nationally 13 to 50 percent of welfare recipients experience multiple barriers - including two or more of the following: lack of child care, disabilities, domestic violence, emergency financial needs, housing instability, lack of health insurance, mental health or substance abuse problems, or lack of transportation - which may impede the ability to work.16
Using administrative data, staff focus groups, and client interviews, a recent study in Utah noted prevalence rates for the following barriers to work:
Clinical depression (42 percent)
Generalized anxiety disorder (7 percent)
Post-traumatic stress disorder (15 percent)
Learning disability (23 percent)
Physical health problems that prevent work (35 percent)
Poor work history (30 percent)
Severe child behavior problems (23 percent)
Severe domestic violence within the last 12 months (12 percent)
The Utah study found that 92 percent of families faced at least one of these barriers to work with many families facing multiple barriers, 26 percent of families faced three barriers, and 37 percent faced four or more barriers to work with longer term welfare recipients reporting more barriers.17
Using the Urban Institute's National Survey of America's Families (NSAF) data for 1997, Loprest and Zedlewski (1999) found that 78 percent of current welfare recipients face one or more barriers to work - including one of the following six barriers:
Very poor mental health or health limiting work;
Education less than high school;
No work experience or having last worked three or more years ago;
Child under age one;
Caring for a child on Supplemental Security Income; or
Loprest and Zedlewski further found that 44 percent of current welfare clients face two or more of these barriers, and 17 percent of clients face three or more of these barriers to work.18
Not all barriers are as likely to co-occur as others. Citing a study by Olson and Pavetti (1996), Johnson and Meckstroth (1998) report that among clients with multiple barriers, low basic skills is the barrier most likely to co-occur, with mental illness, housing instability, domestic violence, and substance abuse also likely to co-occur.19 Johnson and Meckstroth (1998) also review past research and report that 42 to 54 percent of domestic violence victims receiving welfare also suffer from depression. Domestic violence is also likely to co-occur with substance abuse with estimates ranging from 19 to 38 percent of domestic violence victims also reporting drug and alcohol abuse or dependency.20
There is little debate that substance abuse is a common barrier faced by TANF recipients.
Prevalence of Substance Abuse. Estimates of the prevalence of substance abuse among welfare recipients vary widely (based on differing data sources and definitions of substance abuse), although there is little debate that this is one of the common barriers faced by TANF clients. A recent report by the National Center on Addiction and Substance Abuse (CASA) notes findings from a recent state survey indicating that "State TANF administrators consistently identified substance abuse among participants as a pervasive problem...."21 Additionally, substance abuse is considered a factor affecting TANF clients' ability to obtain and retain jobs and was included as one of the eligibility factors for the Welfare-to-Work Grants program designed to help hard-to-serve welfare recipients.
One study that reviewed past research reports estimates ranging from two percent for welfare recipients who sought treatment for substance abuse to 20 percent for welfare recipients who self-reported substance use.22
Another review of estimates notes that nationally five to 27 percent of welfare recipients have a substance abuse problem depending on how it is defined - narrowly where the individual is either an alcoholic or drug user or broadly where the individual is a possible alcoholic and/or drug user.23 Yet another summary notes that 6.6 to 37 percent of welfare recipients have a substance abuse problem depending on the measure used.24
Prevalence of Learning Disabilities. Learning disabilities are another commonly cited barrier to employment faced by TANF recipients. However, there is little consensus on a definition of a learning disability. Often issues of low educational attainment, illiteracy, and even developmental disabilities are grouped under the heading of learning disabilities. The lack of a common definition contributes to the range of prevalence estimates available.
Estimates of learning disability prevalence vary with Johnson and Meckstroth (1998) reporting that past national studies found 25 to 40 percent of welfare recipients have a learning disability or low basic skills. The TANF Program Second Annual Report to Congress reports that up to 40 percent of welfare recipients have a learning disability or low basic skills.25 State studies in Kansas, Utah, and Washington report that it is likely that 20 to 33 percent of welfare recipients have a learning disability with Washington suggesting that up to one-half may have a learning disability.26 While these figures seem quite high, Young (1997) suggests that women experience higher rates of learning disabilities as adults due to gender bias in their youth. Lack of diagnosis of a learning disability in youth results in fewer girls receiving the necessary special education, thus lending credibility to higher estimates given the predominance among adult women, who are most commonly the heads of TANF households.27
Estimates of domestic violence situations vary whether based on current or lifetime victimization rates.
Prevalence of Domestic Violence. Domestic violence is a broad term used to describe abusive or aggressive behavior by a person in an intimate relationship with the victim and may be physical, sexual, or emotional.28 Estimates of domestic violence prevalence vary depending on whether current or lifetime victimization rates are measured. The Center for Impact Research - a leading domestic violence advocacy organization - reviewed five major research studies and reports that 20 to 30 percent of welfare recipients are current victims of domestic violence.29 Similarly, in a review of national studies Johnson and Meckstroth (1998) found that 24 percent of welfare recipients have been "physically victimized or threatened by their current partner sometime during the past five years." Yet another summary by Danziger et al. (1999) notes both current and lifetime domestic violence rates ranging from 10 to 31 percent and 48 to 63 percent, respectively. The only other lifetime prevalence rates we identified are state and local estimates reported by Johnson and Meckstroth (1998) with lifetime domestic violence rates ranging from 29 to 65 percent.
Prevalence of Mental Health Problems. Mental health problem is another broad term used to describe what may be a barrier to work for many TANF recipients. Like learning disabilities and domestic violence, the term mental health problem actually encompasses a number of specific conditions including clinical depression, anxiety, post-traumatic stress disorder (PTSD), and others. In estimating prevalence, many studies report about mental health problems or impairments generally while others measure specific mental conditions.
Using the 1997 National Survey of America's Families (NSAF) data, Loprest and Zedlewski (1999) found that 22 percent of current - and 18 percent of former - welfare recipients said they had very poor mental health. Similarly, Sweeney (2000) summarizing recent research, notes that 20 percent of former welfare recipients who are not working have mental health impairments. Other studies estimate different prevalence rates depending on whether welfare clients meet the diagnostic criteria for depression - 6 to 23 percent - or whether welfare clients show symptoms of depression - 13 to 39 percent.30
Estimates of prevalence for specific mental illnesses vary nationally and from state to state. A review of national prevalence rates for specific mental illnesses indicates that the following percentages of welfare clients met definitions of specific mental health problems. 31
Major depression (27 percent)
PTSD (15 percent)
General anxiety disorder (7 percent)
Michigan found 25 percent of welfare recipients - compared to over 40 percent in Utah - had major or clinical depression. Michigan and Utah found similar rates of PTSD and general anxiety disorder at 14 and seven percent, respectively.32
16 Johnson, Amy and Alicia Meckstroth. Ancillary Services to Support Welfare to Work. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, June 1998.
17 Barusch, Amanda Smith, Mary Jane Taylor, Soleman H. Abu-Bader, and Michelle Derr. Understanding Families With Multiple Barriers to Self Sufficiency. Final Report submitted to Utah Department of Workforce Services. Salt Lake City, Utah: Social Research Institute, February 1999.
18 Loprest, Pamela J. and Sheila R. Zedlewski. Current and Former Welfare Recipients: How Do They Differ? Washington, DC: The Urban Institute, November 1999.
19 Johnson and Meckstroth 1998.
20 Johnson and Meckstroth 1998.
21 The National Center on Addiction and Substance Abuse (in partnership with the American Public Human Services Association). Building Bridges: States Respond to Substance Abuse and Welfare Reform. Washington, DC: CASA, August 1999.
22 Sweeney, Eileen P. Recent Studies Indicate That Many Parents Who Are Current or Former Welfare Recipients Have Disabilities or Other Medical Conditions. Washington, DC: Center on Budget and Policy Priorities, February 2000.
23 Johnson and Meckstroth 1998.
24 Danziger, Sandra, Mary Corcoran, Sheldon Danziger, Colleen Heflin, Ariel Kalil, Judith Levine, Daniel Rosen, Kristin Seefeldt, Kristine Siefert, and Richard Tolman. Barriers to the Employment of Welfare Recipients. Ann Arbor, MI: University of Michigan Poverty Research and Training Center, April 1999.
25 U.S. Department of Health and Human Services, Administration for Children and Families, Office of Planning, Research and Evaluation. Temporary Assistance for Needy Families (TANF) Program: Second Annual Report to Congress. Washington, DC: August, 1999.
26 Sweeney 2000.
27 Young, Glenn, H., Jessia Kim, and Paul J. Gerber. Gender Bias and Learning Disabilities: School Age and Long-Term Consequences for Females. Learning Disabilities: A Multidisciplinary Journal, Vol. 9, No. 3. Pittsburgh, PA: Learning Disabilities Association, 1997.
28 Johnson and Meckstroth 1998.
29 Raphael and Haennicke 1999.
30 Johnson and Meckstroth 1998.
31 Kramer, Fredrica D. Serving Welfare Recipients with Disabilities. Washington, DC: Welfare Information Network, January 1999.
32 Sweeney 2000.