Return to Previous page |
| PDF Version, Color |  |
ASSISTING TANF RECIPIENTS LIVING WITH DISABILITIES TO OBTAIN AND MAINTAIN EMPLOYMENT
Creating Work Opportunities
BY MICHELLE K. DERR AND LADONNA PAVETTI
February 2008
The emphasis on placing TANF recipients into paid employment quickly is consistent with employment assistance approaches employed by several recent demonstration projects (outside of TANF) for youth and adults living with a disability. However, because TANF recipients living with a disability may have other deficits such as low education levels and limited work experience that further limit their employment prospects, they may not be successful at finding paid competitive employment within the time allotted. When this occurs, TANF agencies may choose to create work opportunities outside of the competitive labor market as a first step towards permanent unsubsidized employment. In this practice brief, we profile three programs that use different approaches (unpaid work experience, subsidized employment, and unsubsidized transitional employment) to create work opportunities for TANF recipients who are living with a disability and have not been successful in finding competitive employment.
INTRODUCTION
Improving the employment and other vocational outcomes of individuals living with a disability has long been a goal of policymakers, program operators and individuals living with a disability. In recent years, to advance this goal, the U.S. Social Security Administration has embarked on several major initiatives such as the Ticket-to-Work program and the Youth Transition Demonstration project that aim to improve the employment outcomes of individuals living with a disability. These projects build on earlier research that demonstrates that the most effective way to increase employment among individuals living with a disability is to help them obtain employment directly rather than providing treatment or lengthy pre-employment assessment, training, and counseling.1
This approach is consistent with the employment focus of state Temporary Assistance for Needy Families (TANF) programs. Because TANF recipients living with a disability sometimes lack credentials such as a high school diploma or work experience, they are not always successful in finding paid competitive employment, even with extra job search assistance. To provide work opportunities when the paid labor market fails, some TANF agencies have implemented special initiatives to create targeted work opportunities for TANF recipients living with a disability. Jobs may take the form of unpaid work experience positions (where the clients continue to receive TANF benefits and work for no additional compensation), paid subsidized employment positions (where TANF funds are used to pay clients’ wages for the hours they work), or unsubsidized employment positions (where the TANF program provides support to clients, but the employer pays clients’ wages).
This practice brief is designed to be a resource for policymakers and program administrators interested in creating work opportunities for TANF recipients. The first section describes some of the potential benefits and challenges associated with creating work opportunities. The second section presents case studies of three programs that illustrate how these programs are designed and structured. Finally, looking across the case study programs, we identify the key program elements that may be considered in creating similar programs.
ABOUT THIS SERIESThis is one of four practice briefs examining strategies TANF agencies may consider implementing to help TANF recipients living with a disability to realize their full employment potential. Other briefs in the series include: Conducting In-Depth Assessments, Creating TANF and Vocational Rehabilitation Agency Partnerships, and Providing Specialized Personal and Work-Based Support. These briefs draw on case studies of nine programs that have been implemented by states or county welfare agencies to provide specialized services to TANF recipients living with a disability who have not succeeded in traditional job search programs. None of these programs has been rigorously evaluated, thus, their effectiveness remains unknown. Still, they provide important information on program design and implementation that program administrators can use to craft strategies that take into account their program goals and the unique features of their TANF caseload. These briefs were completed by Mathematica Policy Research, Inc. under contract to the U.S. Department of Health and Human Services (DHHS), Administration for Children and Families. |
THE POTENTIAL BENEFITS AND CHALLENGES OF CREATING WORK OPPORTUNITIES
States and local welfare offices have substantial experience designing, managing and/or operating job search programs, however, they have far less experience with programs that provide TANF recipients with work opportunities. Until recently, states have not needed to operate such programs to meet their TANF work participation requirements. While there are clear benefits to providing these opportunities, there also are challenges that must be addressed to ensure their success.
Potential Benefits
By creating work opportunities for recipients with disabilities, states benefit by engaging recipients who might not succeed in a program targeted to the general TANF population and the program activities can count towards meeting the state’s work participation requirement. Program participants benefit by gaining valuable work experience and learning to manage their disability in the context of work.
Recipients gain valuable work experience. Work programs targeted to TANF recipients living with a disability typically place clients in unpaid or paid entry-level positions within the welfare office, with a contracted service provider, or with a broader community organization where recipients learn appropriate workplace behaviors and new job skills. Placements often are individualized and extra supervision is provided. Extra care is taken to place recipients in positions that are commensurate with their abilities and that can accommodate any special needs they may have. Clients gain work experience and exposure to the conditions and responsibilities of competitive employment, while engaging in activities that meet the federal work requirement.
Recipients learn to manage their disability within the context of work. What distinguishes work programs for TANF recipients living with a disability from traditional work programs is the effort to blend work opportunities with a range of specialized supports and treatment. More intensive support helps recipients obtain the treatment they need to function successfully in the workplace and to address other personal and family challenges that might interfere with their ability to be successful at work. Providing such intensive support alongside work opportunities creates a nurturing training ground where clients can expand their job skills, and learn appropriate workplace behaviors and norms from supervisors, co-workers, and program staff while learning how to manage their disability.
RATIONALE FOR ENGAGING TANF RECIPIENTS WITH DISABILITIES IN WORK ACTIVITIESBeginning in the early 1990’s, prior to the creation of TANF, states began expanding the pool of recipients expected to participate in work-related activities, with some states moving towards universal engagement where all recipients are expected to participate in activities that will prepare them for work. Although federal rules don’t include exceptions or modified requirements for TANF recipients living with a disability, states that have adopted a model of universal engagement often permit recipients with personal and family challenges, including, but not limited to, those living with a disability, to participate in a broader range of activities or for a reduced number of hours, acknowledging that their participation may not be sufficient to count toward the state’s work participation rate.2 The reasons for pursuing a universal engagement strategy include: (1) with time limits on the receipt of cash assistance, recipients cannot expect to rely on TANF in the long run; (2) paid employment is the surest path for achieving self-sufficiency for all, including recipients living with a disability; (3) the TANF system has an employment infrastructure in place that can be expanded and adapted to meet the needs of recipients who need more intensive services and employment accommodations; and (4) TANF agencies, like all public agencies, are required by the Americans with Disabilities Act to provide opportunities for recipients living with a disability to benefit from all the programs, services and activities they offer. |
Potential Challenges
States or local welfare offices seeking to create work opportunities for TANF recipients living with a disability are likely to experience some challenges. Planning ahead to address these challenges may lead to more positive outcomes for recipients.
Achieving full participation. TANF recipients living with a disability, like all other TANF recipients, must participate fully in a work program in order to meet their work participation requirement. However, for participants with disabilities—some that have gone undiagnosed and untreated for many years—it often takes time to achieve a level of stability and develop the planning and time management skills needed to participate fully. While immediate full participation may not be realistic, many recipients may be able to achieve full participation over time with treatment, the right sup-ports, and accommodations. Since such full participation is often used as evidence of recipients’ ability to succeed in unsubsidized competitive employment, programs typically make efforts to foster progress towards full participation as a critical component.
Addressing multiple personal, family, and logistical challenges. In addition to their disabilities, many TANF recipients face other challenges, such as domestic violence, poor housing conditions, unstable living arrangements or limited transportation options that interfere with their ability to work. In order to provide support to recipients who have spent many years moving from one crisis to the next, program staff must be extremely knowledgeable of community resources and teach recipients to anticipate and resolve crises before they occur.
Creating pathways to permanent employment. Once clients acclimate to their work placement, the next hurdle is to transition into a permanent job. Recipients’ fears of leaving the security of cash assistance, intensive personal support, child care assistance and the familiarity of their work placement can sometimes be paralyzing for them. Providing a continuum of support with a clear pathway to competitive employment is critical if recipients are to be self-sufficient.
Securing adequate funding. A key feature of these programs is their provision of intensive support as well as work opportunities, in some cases, making them more costly than traditional employment programs. Because these programs are competing with many other programs for limited resources, they often are hard to get off the ground and even harder to sustain over the long term.
STATE AND LOCAL PROGRAM EXAMPLES
The three programs described below demonstrate how TANF agencies are creating work opportunities for TANF recipients living with a disability. These programs were selected to illustrate three different approaches to creating work opportunities. WeCARE (Wellness, Comprehensive Assessment, Rehabilitation and Employment), a program targeted to all cash assistance recipients living with a disability in New York City, illustrates the creation of work opportunities through unpaid work experience positions. Georgia GoodWorks!, targeted to hard-to-employ TANF recipients, including those living with a disability, illustrates the creation of work opportunities through paid subsidized work placements. Finally, the Diversified Employment Opportunities (DEO) Program in Davis County, Utah, illustrates how unsubsidized transitional jobs can create work opportunities.
New York City’s WeCARE Program: Creating Work Opportunities Through Unpaid Work Experience Positions
New York City’s WeCARE program provides unpaid work experience opportunities to TANF recipients who have medical and/or mental health conditions that may effect their employability. Between the fall of 2005 and June 2007, WeCARE providers served approximately 100,000 clients, many more than once. In addition to TANF recipients, the program also serves recipients of New York’s Safety Net program which provides cash and employment-related assistance to TANF recipients who have exhausted their 60-month time limit and childless individuals who do not qualify for TANF benefits.
The City’s Human Resources Administration contracts with two large local employment and training service providers to operate the program, one local nonprofit organization, Federation Employment and Guidance Service, Health and Human Service Systems, Inc. (FEGS) and one national for-profit employment service provider, Arbor Education and Training. Contracted service providers operate under a hybrid contract arrangement that includes cost-reimbursement for case management services and performance-based payment points structured to encourage job placement and retention.
Clients are assigned to entry-level positions (e.g., building maintenance, food service, retail, clerical) at non-profit agencies where they work up to 30 hours per week alongside permanent paid employees. Recipients’ grant amounts and the provisions of the Fair Labor Standards Act are used to determine the number of hours they are required to work. Work experience hours may be combined with other activities, such as job search and job readiness workshops, adult basic education, and English as a Second Language classes, to help clients prepare for and obtain competitive unsubsidized employment.
Key features of the program include (1) comprehensive assessments that combine medical, psychosocial and vocational information to make informed service and work placement decisions; (2) on-site support and monitoring; and (3) provision of job placement and retention services.
Use of biopsychosocial and vocational assessments to make informed service and work placement decisions. Before being referred for a work experience position, all clients referred to WeCARE complete a biopsychosocial (BPS) assessment that is conducted by a team consisting of a social worker, primary care physician, and, if necessary, one or more medical specialists. Upon completion of the BPS, the physician then makes a determination about the client’s employability, triaging them into one of four categories: (1) work ready, (2) employable with limitations, (3) temporarily unable to work due to unstable clinical conditions requiring treatment, and (4) unable to work for 12 or more months and potentially eligible for SSI benefits.
Only recipients who are employable with limitations are referred for a work experience position (about 42 percent of all WeCARE clients that complete the BPS assessment). Before being referred for a work experience position, recipients receive a comprehensive vocational diagnostic assessment resulting in an individualized plan of employment (IPE). The IPE includes the client’s required work activities, participation hours, and work accommodations and supports. Information from the vocational assessment is used in conjunction with the BPS assessment to match clients to a work placement site where they are most likely to succeed. Many recipients combine work experience with other program activities.
On-site support and monitoring. Once recipients are placed, work experience coordinators serve as a liaison between them and the employer, supporting both as needed. For example, an employer may contact the coordinator if the client is absent from work or if the client’s behavior is creating conflict in the work environment. To ensure the quality of the placement, WeCARE providers require employers to sign a formal agreement defining what they will provide clients such as on-site supervision and training in exchange for their labor. Work experience coordinators conduct monthly on-site visits to employers to monitor the quality of the work placement, to confirm that all required accommodations are provided, and to offer assistance to employers, such as training clients at their work sites. Active monitoring is meant to increase the likelihood that the work experience will be beneficial for employers and clients. In addition to holding employers accountable, work experience coordinators monitor clients’ performance at least monthly and more often if there are problems with participation. In addition to the coordinator, case managers each work directly with clients to resolve personal and family challenges and other work-related issues. At FEGS, case managers each carry caseloads of about 70 work experience participants. When needed, they may link a client to a treatment provider or other needed services in the community. Case managers are required to meet with work experience participants at least monthly.
Provision of job placement and retention services. Job placement and retention services are designed to help work experience participants transition into and maintain permanent employment. Once a client is ready to move into competitive employment, a job developer identifies permanent job opportunities based on the client’s interests and abilities and the work accommodations required. After a participant finds a job, WeCARE providers offer post-employment supports, such as ongoing case management, job retention workshops (e.g., help with accessing transitional benefits and work supports through the TANF agency, seeking job promotions and raises, and resolving workplace conflict), and vouchers for purchasing new business clothing. Clients may also earn incentives in the form of public transportation passes for staying employed and participating in post-employment services. Keeping a job not only benefits the client, but also the WeCARE providers as they operate under performance-based contracts with job retention payment points at 30, 60, and 180 days after the client starts competitive employment. Since the program began, approximately 5,000 WeCARE clients have obtained jobs. One WeCARE provider reported job retention rates of 90 percent at 30 days, 74 percent at 90 days, and 66 percent at 180 days.
Georgia GoodWorks!: Creating Work Opportunities Through Subsidized Employment
Georgia GoodWorks!, a statewide program operated by the Georgia Department of Labor (DOL), provides paid group and community job placements to hard-to-employ TANF recipients who are able to work with additional support. Even though the program does not explicitly target TANF recipients living with a disability, many of those enrolled have physical and mental health conditions that interfere with employment. DOL contracts with agencies that have extensive experience serving individuals living with disabilities and other hard-to-employ populations to provide job placements and intensive supports to clients while they are working.
After an initial assessment period, clients are expected to work at their placement for 32 hours per week and to participate in other federally countable activities (including GED preparation, job skills training, and vocational employment) for eight hours per week. Placements may be in a group setting at the contracted service provider or at individual community placements. Work placements may include entry-level jobs, such as light assembly, cashiering, janitorial, or clerical positions. TANF funds are used to pay clients the federal minimum hourly wage. Paid work placements are available for up to six months; after that, a client transitions into a permanent job. Since the program began in 2000, GoodWorks! has served more than 6,000 TANF recipients and placed 58 percent of those enrolled in unsubsidized employment. In recent years, enrollment has been declining concurrent with TANF caseload declines in the state. In fiscal year 2006, GoodWorks! was contracted to serve 300 clients, but only 120 were enrolled in the program.
Key features of the program include (1) work-based assessments where detailed information about clients’ work skills, attitudes, and behaviors are gathered; (2) work placements with different levels of support; and (3) intensive personal and employment supports.
Work-based assessments. Two assessments, an initial in-depth vocational assessment and a work evaluation, are used to identify clients’ service needs and assign them to a work placement. To determine if a TANF client is appropriate for GoodWorks!, staff from the State Vocational Rehabilitation Agency conduct an in-depth vocational assessment to identify clients’ work abilities, interests, and service needs. This information is used not only to determine if GoodWorks! is a good fit for the client, but also to supplement assessment information gathered during the work evaluation.
People referred to GoodWorks! are evaluated through a temporary work placement at a work site maintained by the contracted service provider. During this work evaluation, recipients combine work and other activities for a total of 40 hours per week. While at the work site, providers evaluate clients’ needs by observing them and gathering information from work site supervisors about their work skills, attitudes, and behaviors. They also attempt to address any personal, family and logistical challenges that may hinder clients’ success at work. At the end of the work evaluation period, which typically lasts between three and four weeks, the provider holds a case conference where, based on assessment results, clients are referred to a work placement.
Work placements with different levels of support. Clients are assigned to a work placement appropriate to their level of employability. Those with limited or no work experience who need more support continue working in a group work site at the contracted service provider. Supervisors at these sites generally offer detailed instruction and support for carrying out job tasks. In addition, work site supervisors typically have experience working with individuals living with a disability. Participants who are more work ready are referred to a range of community placements, including government, nonprofit and for-profit settings. Community placements typically offer less support than in-house group placements and they acclimate clients to a permanent work environment more quickly. Recipients who perform well in a community placement may be hired by the employer.
Intensive personal and employment support. Georgia GoodWorks! provides four primary supports to help clients prepare for steady employment. First, each client is assigned a personal advisor (intensive case manager) who is available 24 hours a day, 7 days a week to help them resolve any personal issues that may interfere with their ability to work. The advisor works intensively with the client during regular and frequent home visits and at the client’s work placement. Small caseloads, between 15 and 30 cases each, allow the advisor to teach clients basic life skills, identify and address their barriers to employment, and build their self-esteem and self-worth. To increase the amount of direct contact with clients, advisors work out of their cars, rather than in an office, with the aid of cell phones and laptop computers. Second, job coaches are available to reshape clients’ workplace habits and develop basic job skills to help them stay employed. At the job sites, coaches teach them to perform work-related tasks and resolve interpersonal issues. Third, GoodWorks! offers logistical support and work support, such as professional clothing or uniforms, shoes, eyeglasses, and tools specific to clients’ jobs. Finally, clients may be linked to specialized services, such as a mental health treatment or the state Vocational Rehabilitation agency for more intensive service needs.
THE PREVALENCE OF DISABILITIES AMONG TANF RECIPIENTSSince the creation of TANF, numerous studies have estimated the prevalence of personal and family challenges, including disabilities, among the TANF population. While the estimates of the fraction of the recipients living with a disability are not consistent across these studies, they all suggest that a substantial portion of the TANF caseload is living with a disability. While the majority of these recipients eventually may be able to find and sustain employment, they may need more specialized assistance and take more time to do so. The disabilities that are reported most commonly among TANF recipients are mental health conditions, learning disabilities and physical health problems. Results from a common survey fielded in six states found that the fraction of TANF recipients reporting a mental health condition ranged from 21 to 41 percent, a learning disability ranged from 8 to 18 percent, and a physical health condition ranged from 16 to 26 percent. Across the six states, recipients with physical and mental health conditions were significantly less likely to be employed than those without these conditions.3 A recent study that uses the Survey of Income and program Participation (SIPP) to compare the characteristics of TANF recipients before and after the implementation of TANF found that the proportion of TANF recipients reporting a work-limiting condition has increased over time. For example, in 1996, 16 percent reported a work-limiting condition compared to 21 percent in 2007.4 |
Support during the transition to competitive employment. Recognizing that the transition to work is not easy, Georgia GoodWorks! provides post-employment services to all program participants. Once a client starts a competitive job, their personal advisor contacts them at least monthly for up to six months to monitor how they are managing their new jobs and family responsibilities. They also act as a mediator between employers and workers and help clients access supportive services and other service needs (e.g., housing, physical or mental health treatment). According to personal advisors, they typically build strong working relationships with clients during the work adjustment period, which makes it easier to provide support during the transition to competitive employment. As recipients become comfortable in their jobs and hone their skills for managing work and family responsibilities, the personal advisors reduce their level of involvement.
Diversified Employment Opportunities (DEO) Program, Davis County Utah: Creating Work Opportunities Through Unsubsidized Transitional Employment
In an effort to increase TANF work participation rates, in October 2006, the Northern Region of Utah’s Department of Workforce Services (DWS) contracted with Davis Behavioral Health (DBH), a large county mental health treatment provider, to provide unsubsidized transitional employment for up to 20 TANF recipients with diagnosed mental health disabilities (e.g., major depression, generalized anxiety, bipolar disorder, and post-traumatic stress disorder) through the Diversified Employment Opportunities (DEO) program. (The program also serves approximately 40 other non-TANF clients.)
The program hires TANF recipients living with a disability as regular employees and pays them $6.50 per hour to perform jobs within the agency’s 14 locations. Jobs include janitorial, food service, landscaping, painting, and clerical positions, among others. Work hours are based on clients’ mental health status. Typically, clients start out with a small number of hours and gradually increase them as their conditions improve and their capacity to work increases. Although recipients’ wages are not subsidized by the TANF agency, because the agency covers the cost of supervision and other supports at the worksite, for purposes of federal reporting, the TANF agency counts recipients’ work hours as subsidized employment.
Specific components of the DEO program include: (1) unsubsidized transitional paid job opportunities for clients, (2) resources for identifying and addressing clients’ mental health needs, (3) work supports and incentives, and (4) ongoing collaboration and service coordination by a team of DBH/DEO and DWS staff and mental health professionals.
THE DEO PROGRAM IN ITS FIRST YEARAccomplishments
Reasons for Recipients Not Completing the Program
|
Unsubsidized transitional paid job opportunities. Participants in the DEO program are able to work at DEO for as long as they want. To decrease their fears, clients are told that they will not lose their job for making a mistake. Instead, program staff use mistakes as teaching opportunities for changing clients’ workplace habits and attitudes. DEO staff and their DWS employment counselors help TANF clients find competitive jobs in the community and clients may tap into a variety of job search and job placement resources at the local employment center. Once they find competitive employment, DWS provides clients with transitional cash assistance, child care assistance, ongoing case management, and other work supports. When clients leave the DEO program for a competitive job in the community, they are told that they can come back to DEO if they lose or quit their job.
Resources for identifying and addressing clients’ mental health needs. Clients are required to combine work with ongoing mental health treatment as a condition of eligibility for DEO. A licensed clinical therapist (LCT) within the welfare office or a DBH therapist diagnoses the client’s condition. Before a client can begin the DEO program, he or she is required to have an ongoing treatment plan with their DBH therapist that includes regularly scheduled visits. The therapist teaches the client coping skills to balance their mental health condition and work, and helps when the stress of work aggravates their mental health condition. In addition, clients are more likely to show up for treatment since it is conveniently located where they are working.
Work supports and financial incentives. DEO provides work supports and incentives to help clients succeed in the workplace. First, a highly experienced employment specialist (intensive case manager), located on the site where clients are working, provides intensive support and rehabilitative counseling to all TANF clients served by the program. As one who also has a disability, she understands first hand some of the challenges clients face with getting and keeping a job. She also helps clients manage their mental health conditions, address their legal issues, and obtain additional training to help them perform their jobs well. Second, work site supervisors, who are often seasoned DEO clients who have been promoted, serve as role models and mentors for clients. They visit clients daily at the job site, providing instruction and encouragement when needed. Third, DEO rewards strong work performance. Clients receive a 50-cent bonus payment for each hour worked during a two-week pay period in which they are on time every day and perform well at their jobs. They may also earn a promotion to a supervisory position, accompanied by a pay raise. Finally, the TANF case manager has considerable flexibility to help clients with logistical supports, such as child care, transportation assistance, work-related clothing, and other related expenses.
Ongoing collaboration and service coordination. Collaboration and shared decision-making is designed to ensure that TANF recipients get needed support. DEO program staff, DBH mental health therapists, and TANF case managers and LCTs hold regular case conferences to coordinate resources, talk with clients who are not progressing, and to discuss whether to increase or decrease clients’ work hours. In addition, they cross-train staff about the TANF program requirements and, from a rehabilitative perspective, how to best help the client succeed. Internally, the DEO employment specialists and clients’ DBH mental health therapists discuss the observed triggers or behaviors that contribute to work disruptions and coordinate an approach to addressing them.
KEY PROGRAM ELEMENTS
Although these three programs have unique structures and use different strategies for providing work opportunities, five elements common to all of them distinguish them from traditional employment programs: (1) specialized and comprehensive assessments, (2) initial and ongoing treatment for disabling conditions, (3) individualized work placements, (4) intensive personal and work supports, and (5) progressive steps toward permanent employment.
Specialized and comprehensive assessments. TANF recipients living with disabilities sometimes have complex service needs that require an individualized approach to work placements and supports. Recipients often are referred to specialized work programs because they have not been successful in more traditional programs. To better map recipients’ strengths and limitations, service delivery in work programs for TANF recipients living with disabilities typically begins with specialized and comprehensive assessments.
While more costly and time consuming than traditional assessments, specialized and comprehensive assessments expose a client’s presenting conditions and create an opportunity for a licensed professional to tailor the type of work placement, number of participation hours, work accommodations, and types and intensity of work to the client’s needs. Assessment results are combined with clients’ work interests to identify work placements that match their functional abilities with the demands of the job and physical work environment. The assumption is that a good match will increase the likelihood that a client thrives at the work placement.
As shown by the three programs’ approaches, there are many different ways to conduct in-depth assessments. But, regardless of the structure, in-depth and specialized assessments are typically conducted by a licensed or highly-trained professional. Professionals may be employed in-house at the local welfare office or by a contracted service provider. In some cases, they might also be employed by a partner agency, which has an established and ongoing relationship with the welfare office or contracted service provider.
Initial and ongoing treatment for disabling conditions. For TANF clients living with a disability, the pathway to work is often laden with serious conditions that have gone undiagnosed , untreated, or both. Such conditions may include physical health problems, such as diabetes or hypertension; or more commonly, clinical mental health conditions, such as major depression, bipolar disorder, generalized anxiety, or post-traumatic stress disorder. Left untreated, these conditions create serious impediments to participation in work and TANF program activities.
Clients living with a disability may require treatment to stabilize their clinical condition before they are assigned to a work placement, and often they need to maintain treatment during work. Once clients’ specific conditions are identified, they may need treatment from a primary care physician, psychiatrist, or other specialist. Then, regular follow-up appointments may be used to monitor the clients’ conditions over time, particularly while they adjust to new medication or the stress of balancing work and family responsibilities. Follow-up also allows treatment providers to teach clients how to effectively manage their physical and/or mental health conditions, and treat short-term crises, if necessary.
Some TANF agencies create formal partnerships or service agreements with physical and mental health treatment providers in an effort to improve access to treatment for their clients. Such partnerships include provisions that allow clients to be treated on short notice. In addition, treatment providers also educate welfare agencies about how a disability may influence a client’s employability; and in return TANF agencies inform treatment providers about TANF program requirements.
Individualized employment placements. Each of the programs discussed aims to match recipients with work placements that are consistent with their abilities and interests. Programs use two primary approaches to individualize work placements: they alter the work environment and required tasks according to the client’s needs, or they identify an existing placement that is a good fit for the recipient. To accomplish the former, programs need staff that can negotiate with potential employers or work sites to implement appropriate accommodations, such as reorganizing and reallocating job tasks, altering recipients’ workspace, and providing adaptive equipment. To accomplish the latter, programs need to have a diverse pool of employment placement options available and staff who are skilled at making good job matches.
To create a diverse array of work opportunities (regardless of how or whether recipients are paid), providers may offer a broad range of jobs in one site and/or maintain a large and diverse pool of placements in government agencies and/or nonprofit or for-profit agencies in the community. The advantage of offering multiple jobs in one site is that it is easier to provide daily intensive support, supervision, and direction for recipients. In addition, on-site placements allow program staff with different responsibilities (e.g., case managers and supervisors) to communicate regularly and observe clients’ job performance firsthand to assess their participation and progress. The advantage of community placements is that work more closely resembles competitive employment. TANF recipients work alongside permanent employees and are exposed to the daily demands and work environment of a job. In addition, clients that perform well at their work placement may be hired by the agency. At either type of placement, the types of tasks that the placement requires must align well with clients’ abilities and interests to be useful. Job matching is critical in both types of placements, but because it is easier to change jobs within an on-site placement (and recipients often are encouraged to try out different jobs), it is more critical in placements that are scattered throughout the community.
Intensive personal and work supports. Intensive personal and work support is a key element of each of the programs, but is especially important in two, Georgia GoodWorks! and the Utah DEO program. In Georgia GoodWorks!, personal advisors work as resource locators, teachers, advocates, and motivators. In Utah’s DEO program, the employment specialist provides intensive employment support and case management on-site; case managers and mental health counselors in the TANF office provide additional support. In both programs, staff are highly skilled and carry small caseloads of no more than 30 recipients. Working individually with clients, staff teach them basic problem-solving and life skills to help them organize, prioritize, and manage their lives. Some of the skill-building activities include arranging back-up transportation and child care, determining financial priorities, and learning effective ways to communicate and manage their anger. They also look for opportunities to encourage and praise clients’ positive behaviors and program successes to build their self-esteem and self-worth.
In addition to intensive case management, both programs offer job coaching as a temporary support at recipients’ work sites to help recipients learn the hard and soft skills they need to succeed on the job. They are also key informants as they alert intensive case managers of clients’ personal and family challenges that may be interfering with work. Job coaches may be designated staff, work-site supervisors or both, depending on the program.
Due to funding constraints, New York City’s WeCARE is not able to provide the same level of intensive support for all clients that the other programs provide and program administrators recognize the caseload size as an area that could be improved. Case managers who carry caseloads of 60 to 70 are required to see recipients at least once a month, whereas case managers in the other two programs see recipients daily or at least weekly. In order to partially compensate for the large caseloads, specialized staff supervise the WeCARE frontline case managers. Work experience coordinators also provide support by acting as a liaison between the participants and the employer.
While case management and job coaching/work site supervision are central to work programs for TANF recipients living with disabilities, other key program supports supplement these activities, including work accommodations (e.g., hearing aids, eyeglasses, adaptive technologies) and basic work supports (e.g., transportation assistance, professional clothing, work-related equipment). These supports are typically available through the TANF agency.
Progressive and flexible steps toward employment. The transition to permanent competitive employment for TANF recipients living with disabilities often is a slow process. Many have limited or sporadic work histories and live with a serious disability that may have gone undiagnosed and untreated for a long time. Even though welfare reform has created an environment that encourages rapid employment placement, programs that serve individuals living with disabilities acknowledge that the transition to unsubsidized employment will not be the same for each recipient—and will not occur quickly for many. Program administrators estimate that the transition is likely to take between six months and a year for most and far longer for some.
All three programs acknowledge that the path to work involves many small steps, but programs handle the progression differently. WeCARE uses a triage system to place recipients on an appropriate service path. Forty-two percent of those who complete the initial assessment are determined able to participate in work activities, the majority of whom are assigned to an unpaid work placement with appropriate work supports or accommodations. When they are ready, they tap into in-house job placement resources to find competitive employment. Most of those remaining have serious disabling conditions and are placed on a Wellness or SSI service track in which they are not required to participate in work or work-related activities. To encourage a steady and timely progression toward work, Georgia GoodWorks! created discrete transition points and timelines beginning with a three- to four-week work evaluation followed by work adjustment, in which a client is assigned to a work placement for up to six months. After work adjustment, clients are required to seek a permanent unsubsidized job in the community. They typically rely on existing job placement resources available to all TANF recipients, or providers may recruit work placement sites that are willing to hire clients who perform well. As a relatively new program, DEO has not defined a clear pathway to jobs in the community; however, the expectation is that recipients will gradually increase their work hours at DBH. This expectation is formalized in the performance-based contract between DWS and DBH. Three-fourths of the total payment amount per participant is earned by achieving a steady increase in a client’s work hours at DBH and job placement and retention in a competitive job in the community.
Structuring contracts to encourage job retention creates an incentive for programs to provide post-employment services and regular follow-up with employed clients. Each of the programs highlighted operate under performance-based contracts with payment benchmarks that focus on job retention up to 180 days. As a result, programs follow up with clients for payment purposes to document that they are working and to provide post-employment supports to keep them employed.
CONCLUSION
Research has estimated that a nontrivial portion of TANF recipients lives with some type of disability. Recent changes in federal laws and regulations that require states to engage more TANF recipients in work activities has encouraged states and local welfare offices to create new work opportunities for recipients living with a disability who are unable to secure or sustain competitive employment on their own. As the program examples highlighted in this practice brief illustrate, work opportunities may be paid or unpaid and, if paid, may be subsidized or unsubsidized. Regardless of their structure, the work programs we examined that were targeted to TANF recipients living with a disability share several common features, including specialized and comprehensive assessments, support for specialized treatment, intensive personal and employment support, and flexible and progressive paths to employment. Program administrators believe that small caseloads and highly trained staff are critical to the success of these programs.
With one exception (below) none of these programs have been rigorously evaluated, so we do not know whether they will, in fact, increase participation in employment activities for TANF recipients living with a disability. We also do not know whether one model or one or more elements (e.g., paid employment and intensive case management) might produce greater impacts than other elements (e.g., unpaid employment and on-site support). However, recent findings from a rigorous evaluation of the Personal Roads to Individual Development and Employment (PRIDE) program, the precursor to WeCARE in New York City, provide some reason for optimism as well as caution.5 Recipients who were required to participate in PRIDE were significantly more likely to participate in work experience and job search activities and to find paid competitive employment than those who were not assigned to the program. However, even though the program produced significant increases in employment, over the two-year period, the majority of program participants never worked and only a small portion worked at any point in time. For example, over the two-year follow-up period, about a third of those assigned to the program found competitive employment, compared to just over a quarter of those not assigned to the program. Average quarterly employment for those assigned to the program was about 16 percent compared to 13 percent for those not assigned. Recipients assigned to the program also were significantly more likely to be sanctioned (32 percent) than those not assigned (8 percent). These findings suggest that although programs like the ones described in this brief may have some potential to help both recipients find work and states increase their work participation rates, the actual increases in the work rate may be relatively modest, and some of the recipients to whom the programs are targeted may not be able to meet the program requirements. WeCARE was designed to improve upon the PRIDE program, so it is possible that WeCARE and other programs like it may produce greater gains in participation and employment.
PROJECT BACKGROUND AND SITE SELECTIONThis study was conducted by Mathematica Policy Research, Inc. under contract to the Administration for Children and Families at the U.S. Department of Health and Human Services (DHHS). There were two objectives of the study. The first was to provide TANF program administrators with information on strategies they could consider implementing to help TANF recipients living with a disability reach their full employment potential. (For purposes of the study, a disability was defined as any mental, physical, or cognitive limitation that has the potential to affect TANF recipients’ employment prospects.) The second was to identify potential opportunities to advance our understanding of the most effective strategies for helping TANF recipients living with a disability find and sustain paid employment through rigorous random assignment evaluations. To accomplish these objectives, MPR conducted a process and implementation analysis in nine sites utilizing qualitative case study methods. To identify sites for the study, MPR attempted to uncover as many programs as possible using four sources of information: (1) available documents (such as reports, journal and Internet articles, and newsletters); (2) recommendations from TANF and disability experts; (3) recommendations from federal officials; and (4) ongoing MPR studies for DHHS on TANF employment programs and for the Social Security Administration (SSA) on promising strategies for promoting employment among persons with disabilities. From the full list of programs, MPR and DHHS collaboratively selected a smaller set that would likely be of most interest to other states and localities, as well as be most feasible to implement. We conducted in-depth, in-person visits to seven sites and telephone interviews with program administrators and staff in two. The site visits and telephone interviews were structured to gather detailed information on program design and implementation, focusing on the issues that would be of most interest to program administrators. |
1 Bond, Gary R., Paul Wehman, and David C. Wittenburg. Evidence-Based Practices That Promote Employment of People with Disabilities." Richmond, VA: Rehabilitation Research and Training Center on Workplace Supports and Retention, Virginia Commonwealth University, 2005. (back)
2 Kauff, Jacqueline, Michelle K. Derr, and LaDonna Pavetti. "A Study of Work Participation and Full Engagement Strategies." Washington, DC: Mathematica Policy Research, Inc., September 2004. (back)
3 Hauan, Susan, and Douglas, Sarah. "Potential Liabilities Among TANF Recipients: A Synthesis of Data from Six State TANF Caseload Studies." Washington, DC: U.S. Department of Health and Human Services. 2004. (back)
4 Bavier, Richard. "Prevalence and Dynamics of Disadvantaged Recipients in the TANF Caseload." Washington, DC: Office of Management and Budget, September 2007. (back)
5 Bloom, Dan, Cynthia Miller and Gilda Azurdia. "Results from Personal Roads to Individual Development and Employment (PRIDE) in New York City." New York, New York: MDRC. July 2007. (back)
| Return to Previous page |