Tribal Self-Governance Health Care and Social Services Delivery Effectiveness Evaluation Feasibility Study: Draft Literature Review - Revised Report. V.2 Studies of Tribal Management of DHHS Social Services Programs


Even though evidence on the impact of self-governance of IHS health programs is limited, it may be possible to gather insight on the effects of Tribal management of services from the literature on Tribal management of social services and non-IHS health programs. One program for which evidence concerning the impact of Tribal management is available is Temporary Assistance to Needy Families (TANF).

The 1996 Personal Responsibility and Work Opportunity Reform Act (PRWORA), which replaced the Aid to Families with Dependent Children (AFDC) with TANF, included provisions that permitted Tribes to operate their own TANF programs. Under the Tribal TANF (TTANF) program, and unlike State TANF programs, Tribes have the flexibility to establish their own work participation goals and to identify the work-related activities that may meet their self-designated work participation goal. Moreover, whereas State TANF participants are eligible to receive cash benefits for a period of up to 60 months, TTANF programs may determine their own time limits. According to the Department of Health and Human Services, Administration for Children and Families (2002), in 2001 a total of 34 Tribal TANF programs, representing 172 Tribes, had been approved.

Despite a national trend toward decreased caseloads, Tribal caseloads have increased or remained the same since the inception of the TTANF program (GAO, 2002). Research to understand the reasons for this growth and the impact of TTANF programs has focused largely on describing the demographic and socio-economic characteristics of persons served by TTANF programs and the economic conditions (e.g., high unemployment rates, lack of skilled labor), social conditions (e.g., lack of child care or employment supports), and the physical infrastructure (e.g., poor roads, limited public transportation, lack of telephones) that may pose barriers to Tribal implementation of these programs or that prevent TTANF programs from achieving their employment goals (Pandey et al., 1999; Pandey et al., 2000; Pandey et al., 2001; GAO 2002.)

Few studies, however, have directly examined the extent to which Tribal TANF programs are achieving their intended objective of promoting independence through employment. The data on work participation rates that has been reported by the Administration for Children and Families (2002) do indicate that TTANF work participation rates average about 37 percent, with approximately one-third of these individuals engaged in unsubsidized employment, one-third engaged in job search activities, and 8 percent engaged in unpaid work. Other program participants were engaged in TANF eligible activities such as subsidized employment, education and vocational training. Because data on the work participation rates of American Indians who participate in State TANF programs were not reported, it is not possible from this study to ascertain how TTANF programs perform relative to State programs. A GAO (2002) study also noted that, in fiscal year 2001, 43 percent of State TANF recipients were involved in work activities (compared to 37 percent of TTANF recipients). Moreover, 60 percent of persons in State TANF programs were in unsubsidized jobs, compared to only one-third of those in Tribal TANF programs.

Insight on the performance of TTANF programs may be gleaned from a series of studies conducted by staff at the Kathryn M. Buder Center for American Indian Studies (Pandey et al. 1999, 2000, 2001). Staff associated with this Center conducted multiple waves of interviews with members of American Indian families, located on three Arizona Reservations, that were currently or had previously received welfare. A total of 350 persons were included in their second round of interviews. Of the Tribal TANF recipients, 15 percent found employment and exited TANF. Although this figure is substantially lower than national estimates of employment of TANF recipients (23 percent), it represents an increase from the previous survey round, when only 11 percent were able to find jobs and exit TANF.(7) Between the first and second wave of interviews, the proportion of current and former welfare recipients that received employment income increased from 12 percent to 27 percent and the proportion with a checking or savings account increased from 17 percent to 26 percent. Nonetheless, approximately one-quarter of TTANF participants who had transitioned to work were unemployed within three months and one-half were unemployed a year later (Kathryn M. Buder Center for American Indian Studies and Native Nations Institute for Leadership, Management and Policy, 2001).

Closely associated with the Tribal TANF program is the Native Employment Works (NEW) program, which was initiated in 1997 to make work activities or employment opportunities available to Tribal members, and the Welfare-to-Work (WTW) program, which provides funds for welfare recipients to transition to work. Approximately 78 Tribes established NEW programs during the first year of implementation. According to the Administration on Children and Families (2001), despite barriers in implementing NEW programs that included inadequate staffing, limited employment opportunities on or near Tribal lands, inadequate equipment and funding, between 1999 and 2000, 44 percent of persons participating in NEW completed the program after meeting one or more objectives.

Empirical evidence on the impact of the Tribal WTW grant program is unavailable. One of the few studies that evaluated the Tribal WTW (Hillabrandt, 2001) consisted of site visits to 10 of 92 Tribal WTW grantees; Tribes were selected based on the whether they had a "comprehensive and innovative" program. Although this study did not directly evaluate the effectiveness of Tribal WTW programs or the characteristics of programs that may enhance or limit their effectiveness, it did identify barriers to Tribes' implementation of these programs. Among the barriers that Tribes encountered were difficulties in identifying and recruiting participants, difficulties in certifying eligibility, and difficulties in getting people enrolled and encouraging them to continue to participate in the program.

The Tribal Child Care Grant (CCG) program is another social service area that Tribes may manage under contractual arrangements. Again, there is little information on factors associated with effective management or impacts. The CCG program is premised on the assumption that with adequate childcare many unemployed low-income persons could enter the work force. The CCG provides low-income families with child care subsidies. In 2002, over 260 Tribal organizations received a grant under the CCG program (Crow, 2002). As stated, we know little about the effectiveness of the Tribal CCG program. In one of the few studies that have examined this program, the U.S. Department of Health and Human Services, Office of Inspector General (OIG), conducted site visits to 29 Tribes. From interviews with Tribal child care administrators, employees and child care representatives, the OIG concluded that Tribes perceived Tribal management of the CCG program increased access to culturally sensitive child care programs and allowed Tribes to meet the unique needs of their community. However, lack of communication and coordination across State and Tribal programs was thought to lead to increased costs, wasted resources and, in some cases, duplicate payments.

Literature was not found on the impact or effectiveness of other Tribally-managed social services programs administered under the Administration for Children and Families, including Child Welfare Services, Community Services Block Grant, the Promoting Safe and Stable Families Program and Grants for Battered Women's Shelter Program.