Providing Mental Health Services to
TANF Recipients:
Program Design Choices and
Implementation Challenges in Four States

Final Report

August 2001

Michelle K. Derr
Sarah Douglas
LaDonna Pavetti

Contents

Executive Summary

Acronyms
Acknowledgements

Chapters:

1. Introduction and Overview of the Study
   1. Context for the Study
   2. Rationale for Integrating Mental Health Services into TANF Programs
      1. Higher-Than-Average Incidence of Mental Health Conditions among Low-Income Families and Certain Minority Groups
      2. Higher-Than-Average Incidence of Mental Health Conditions among Welfare Recipients
      3. Strong Relationship between Mental Health and Employment
   3. Description of the Study
      1. Initial Identification of Programs Designed to Address the Mental Health Needs of Welfare Recipients
      2. Selection of the Sites
      3. Data Collection
2. Designing a Mental Health Service System for TANF Recipients
   1. Types of Services
      1. Screening and Assessment
      2. Linking Clients to Existing Community Mental Health Treatment Services
      3. Targeted Short-Term Mental Health Counseling Services
      4. Expansion of Existing Mental Health Services
      5. Training/Consulting for Employment Case Managers
      6. Intensive Case Management
      7. Assistance in Applying for SSI (Supplemental Security Income)
   2. The Population Targeted for Services
      1. Adults on TANF
      2. Adults Transitioning off TANF
      3. Children in TANF Households
      4. Low-Income Families
   3. Defining the Range of Needs to be addressed
      1. Primary Focus on Mental Health
      2. Primary Focus on Mental Health and Substance Abuse
      3. Broad Focus on a Variety of Personal and Family Challenges
   4. Identifying Clients in Need of Assistance
      1. Broad Screening for Mental Health Needs and Informing Clients about Services
      2. Referrals by Employment Case Managers
      3. Automatic Referrals to Mental Services
      4. Community Outreach
3. Creating an Infrastructure to Provide Mental Health Services
   1. Developing an Administrative Structure for the Program
      1. Utah: TANF Agency Provides Mental Health Services
      2. Oregon: Contracted Provider or Employment Services Agency Provides Mental Heath Services
      3. Tennessee: Contracted Agencies Administer and Deliver Mental Health Services
      4. Florida: Mental Health Agency Administers the Program and Contracts with Providers to Deliver Services
   2. Program Staff
      1. Outreach Workers
      2. Mental Health Counselors/Specialists
      3. M.S.W. Interns
      4. Intensive Case Managers
   3. Service Location
      1. Welfare Office/Employment Center (Co-located Workers)
      2. Contracted Service Providers
      3. Other Locations
   4. Funding Arrangements

   Key Implementation Issues

   1. Strategies to Encourage Employment Case Managers to Refer Clients to Mental Health Services
   2. Strategies to Encourage Clients to Participate in Mental Health Services
   3. Integrating Mental Health Services into Work Activities
   4. Creating a Professional Support Network for Mental Health Staff
   5. Monitoring and Tracking Client Participation in Mental Health Services
   6. Considerations in Providing Mental Health Services in Rural Areas
4. Conclusions

References

Appendix A: Profile of the Study Sites
Appendix B: Program Forms for Screening and Assessment

List of Tables

I.1 Summary of Key Program Dimensions

I.2 Prevalence of Specific Mental Disorders among Welfare Recipients

I.3 Study States and Selected Urban and Rural Sites

II.1 TANF-Funded Mental Health Services Provided in the Study States

Obtaining a Printed Copy

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