The U.S. Department of Health and Human Services (HHS) oversees a wide range of programs that target various populations, some including people who are homeless. Temporary Assistance to Needy Families (TANF) is extended to low-income families with dependent children, who automatically become eligible for Medicaid, one of the two largest federal health insurance programs, and several types of social services. Welfare reform efforts during the 1980s and 1990s have left TANF and related programs with a strong emphasis on employment and promoting family self-sufficiency. HHSs Administration on Children and Families also funds transitional living programs for homeless youth.
The programs managed by HHSs Substance Abuse and Mental Health Services Administration (SAMHSA) focus on people with mental illness and people with substance abuse disorders, including people who are homelessness. SAMSHA targets homeless people directly through the Projects for Assistance in Transition from Homelessness (PATH) formula grants and a number of current and past demonstration programs, including Access to Community Care and Effective Services and Supports (ACCESS). Many of SAMHSAs employment efforts are collaborative initiatives with other federal agencies (DOL, HUD, and VA).
Temporary Assistance for Needy Families
Ten years ago, Temporary Assistance for Needy Families (TANF) replaced Aid to Families with Dependent Children (AFDC) as the nations welfare program. Federal funds are distributed to states, each of which operates its own TANF program under broad federal standards. In addition to cash assistance, TANF offers several types of support services to low-income families, including many homeless families. TANF benefits are paid monthly and are time-limited; while there are exceptions, the general rule is that no family may receive federally funded assistance for more than five years.
TANF and Homelessness. The NSHAPC indicated that 52 percent of homeless families were receiving welfare (it was still AFDC at the time the survey was done) (Burt, Aron, & Lee, 1999). No recent research has updated this percentage, but given the substantial declines in TANF caseloads, it seems likely that fewer homeless families are receiving these benefits. A recent study found that families reaching their TANF time limit or sanctioned for failing to comply with TANF rules are among those particularly vulnerable to housing instability and homelessness (Mills et al., 2006).
The TANF program requires that non-disabled adult recipients work or take part in job training or other educational programs as a condition of receiving benefits. Specific options vary by state; for example, some states have allowed TANF recipients to attend college while receiving benefits, while others do not allow it unless recipients are also working.
Research evidence shows that mandatory work participation programs, which sanction uncooperative TANF recipients by reducing or eliminating their monthly TANF grants, can increase homelessness. One study, based on a random assignment evaluation of a mandatory work program in Connecticut, found that 2.6 percent of the program group reported being homeless and living on the streets and 9.9 percent had to live with family or friends (doubling up). The rates were 1.5 percent and 6.4 percent respectively for the control group, both significantly lower than for the program group. Qualitative data led the evaluators to conclude that these impacts on homelessness were caused by these penalties and by TANF time limits (Bloom, Riccio, & Nandita, 2002).
TANF Employment Supports. States spend a significant portion of their TANF funds on work supports. Just over one-third of all TANF spending goes to cash benefits, while 18 percent is spent on childcare, 8 percent on work support or employment programs, 2 percent on transportation, and 24 percent on other services (Coven, 2005). When recipients go to work, they may have access to childcare, transportation, and other resources needed to get to work and maintain employment. The benefit calculation process also provides an incentive for TANF recipients to work; benefits are reduced by less than one dollar for each dollar in earned income that a family receives.
However, availability of many work supports is dependent on sufficient funds to provide them. Since 1996, TANF payments to states have been provided in block grants at flat annual amounts. Due to inflation, these funds are not worth as much as they were 10 years ago. As a result, states have been forced to cut TANF spending, and many of the first cuts to be made came in work supports such as childcare and transportation (Coven, 2005).
The TANF disability rules are much less restrictive than the SSI standards. Typically, a doctors letter attesting to an inability to work is sufficient to have an adult exempted from TANF work requirements. In most cases, states have not focused their employment support and job training efforts on households headed by persons with disabilities. Instead, those households have been exempted from time limits and allowed to continue receiving cash assistance. The impact of these policies has not been carefully studied.
Employment services provided by TANF are the subject of a vast evaluation research literature, which has been summarized by Blank (2007). Several studies suggest that employment, training, and support services provided to the most disadvantaged TANF recipients, including those who have been homeless, can produce positive results. One example is the evaluation of Welfare-to-Work Strategies, which rigorously evaluated the impacts of 20 programs on employment and other outcomes, and analyzed impacts for particularly disadvantaged recipients (Michalopoulos & Schwartz, 2000). This and other studies (Danziger & Seefeldt, 2002) have looked at the effectiveness of employment supports for very disadvantaged TANF families, although none have isolated the impacts of employment services on homeless families.
The Job Opportunities for Low-income Individuals (JOLI) program is a discretionary grant program administered by the, HHS Administration for Children and Families Office of Community Services. Its purpose is to provide technical and financial assistance to create employment and business opportunities for individuals receiving TANF and for other low-income individuals, including homeless people, with incomes not exceeding 100 percent of the official federal poverty guidelines. Over a three-year period, grantees are expected to help low-income participants achieve self-sufficiency through business expansion, new business ventures, micro-enterprise development, or other non-traditional strategies. Among the 47 JOLI grants to communities across the country from 1998 to 2001, six projects included homeless people among their targeted populations, but no project specifically aimed at or tailored its services for homeless individuals. Largely qualitative evaluations have been conducted for individual JOLI grants, but generalizable research results are not available.
Other Efforts to Help Homeless Families Become Self-Sufficient. A number of initiatives have sought innovative strategies to stabilize homeless families, most of which are current or former TANF recipients, and help them move towards self-sufficiency. These initiatives typically utilize TANF funds together with resources from HUD, other agencies, and sometimes private sources.
One such initiative is Sound Families, a transitional housing venture in the Seattle area funded by the Gates Foundation, as well as government agencies. Reporting on the 292 families in Sound Families, of which nearly two-thirds were still TANF recipients at intake, Bodonyi et al. (2004) reported positive changes in the primary caregivers resources between entry into transitional housing and exit. Employment increased from 27 percent at intake to 50 percent at exit; TANF reliance decreased from 64 percent at intake to 44 percent at exit. However, the average hourly wage earned at intake and exit did not significantly increase, holding steady at approximately $9.25, which is several dollars below the self-sufficiency wage needed to support a family with only one child in the Puget Sound region.
A follow-up report on the Sound Families initiative suggests a possible relationship between preentry employment and program completion. Data indicate that those unsuccessfully exiting the project were slightly more likely to be receiving TANF and less likely to have income from any level of employment. They were more likely to be receiving Medicaid and less likely to be receiving child support (Bodonyi et al., 2006).
Another initiative, Hearth Connection in Minnesotas Twin Cities, is using a network of service providers to test a managed care approach to ending homelessness for families and single adults. The pilot program tries to coordinate assistance to families and individuals from the Minnesota Family Investment Program (MFIP), which is Minnesotas TANF program, and the Social Security Administration while also providing supportive housing (see additional discussion of supportive housing under U.S. Department of Housing and Urban Development). Four years into the pilot, respondents in family programs reported support from food stamps, TANF, earned income, rent support, and child support, while singles were more likely to report receiving income from Social Security and SSDI (National Center on Family Homelessness, 2004). With many of their survival needs met, few participants worked. Those who did not have jobs noted that their daily activities were limited to walks, watching television, and occasionally talking with friends. Many participants wished they could find and keep a job, even a non-paying job. These feelings were echoed by service providers, who wanted more funds and resources for creating employment opportunities (National Center on Family Homelessness, 2006).
SAMSHA Demonstrations for Homeless People with Mental Illness. Among SAMHSAs demonstrations, the Access to Community Care and Effective Services and Supports (ACCESS) demonstration program, funded for five years beginning in 1993, produced the most noteworthy results (Randolph et al., 2002; Morrissey et al., 2002; Rosenheck et al., 2002; Pickett-Schenk et al., 2002; Goldman et al., 2002). The ACCESS initiative sought to improve performance and integration of services to reduce homelessness among persons with serious mental illness. More than 35 journal articles used client-level data from the 18 demonstration sites across nine states (Illinois, Connecticut, Missouri, North Carolina, Pennsylvania, Texas, Virginia, and Washington). Of particular interest for this paper are those investigations that addressed themselves to the employment status of the participants (Lam & Rosenheck, 2000; Cook et al., 2001; Pickett-Schenk et al., 2002; Min, Wong, & Rothbard, 2004).
The research design of the ACCESS project involved a comparison of two service delivery models and the results of these in reducing homelessness as well as making improvements in well-being, such as decreased hospitalizations, increased quality of life, and reduced service use. The first intervention was an effort to integrate services at a systems level in conjunction with outreach and case management. The second condition included an outreach and case management strategy absent a systems-level integration component. Researchers used client-level data and a systems-level evaluation to measure the impacts.
In an examination of nearly 5,000 demonstration participants, researchers found that despite receiving relatively few job-related services, modest but significant increases in employment occurred across 12 months of participation. Those employed at 12 months were more likely to have received job training and job placement services, suggesting a relationship between receipt of employment services and positive vocational outcomes (Cook et al., 2001).
A review of the work histories of 7,228 homeless individuals with mental illness in the ACCESS demonstration supports this conclusion. Earlier studies indicated that lengthy periods of homelessness posed a major barrier to employment for the mentally ill population (Lehman et al., 1995; Ratcliff, Shillito, & Poppe, 1996). However, in the ACCESS study, having been homeless for a long time was not a significant predictor of employment status.
Severe psychiatric illness, however, did emerge as a significant predictor of employment status. Clients with a mental health diagnosis but who appeared not to be hindered by this obstacle those who had not used mental health services, had never been hospitalized, and did not have schizophrenia were more likely to have worked for pay in the month prior to enrolling in ACCESS. Most interesting, however, is that, holding all other factors equal, clients who received job training assistance prior to enrollment into ACCESS were one and a half times more likely to be employed at the programs conclusion, while people who also received help in finding a job were two and a third times more likely to find employment. These results suggest that homeless people with serious mental illness can use vocational services, and that receipt of these services is significantly associated with an increased likelihood of being employed (Pickett-Schenk et al., 2002).