As noted throughout this report, one reason TANF agencies may want to involve other organizations in their efforts to identify unobserved barriers to employment is that TANF agency staff often do not have the skills or training to conduct such assessment or diagnosis. This being the case, they must still be able to understand and act on the assessment and diagnostic results from medical professionals. While this is, on the one hand, an issue of training TANF staff, it can also be considered within the context of outreach to partners.
For example, several states have already undertaken efforts to revise their forms used for medical verification of a disability or barrier to employment to provide information not only about the client's limitations, but also her capabilities. However, TANF staff offer examples of situations where doctors' concerns about liability issues affects how they complete the forms. For example, because of liability concerns associated with indicating that an individual can participate in work activities, doctors take what some TANF staff consider a "conservative" approach in indicating a client cannot participate.
Some TANF staff are concerned that medical professionals do not understand how assessment information they provide interacts with TANF policies.
While TANF staff generally acknowledge that they do not have the medical training to question an assessment or diagnosis, they are concerned that medical professionals do not understand how this assessment information interacts with TANF polices - specifically time limits - to produce what may be a negative result for the client. Consider the example of a client who has a serious back problem that affects her ability to work. A doctor might indicate that the condition should preclude participation in any work activity, while not understanding that a deferral will cause the client to use valuable time on her time clock while not progressing toward finding a work situation that accommodates her condition. If the doctor were instead to indicate that the individual can work, but for limited hours or in certain conditions (i.e., work must be conducted sitting, no heavy lifting should be required), the client could then receive employment services to assist her on her path to self-sufficiency.
Illinois has addressed this problem by creating a form letter that is attached to medical verification forms to be completed by doctors. Not only does the form ask for additional information about the individual's capabilities as well as her limitations, but the form letter explains TANF rules and the implication of a client unnecessarily delaying efforts toward self-sufficiency. The letter also clarifies that nothing about the medical diagnosis will affect the client's receipt of medical assistance which pays for the doctor's services. 84
84 Holcomb 2000.