U.S. Department of Health and Human ServicesU.S. Department of Health and Human Services
This report was prepared under contract #HHS-100-99-0003 between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the Urban Institute. The HHS Administration for Children and Families also provided funding for this project. For additional information about the study, you may visit the DALTCP home page at http://aspe.hhs.gov/daltcp/home.shtml or contact the ASPE Project Officer, William Marton, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. His e-mail address is: William.Marton@osaspe.dhhs.gov.
Welfare reform efforts and significant caseload declines have resulted in a commonly held belief that those remaining on welfare face multiple barriers to employment, or are in some way "hard-to-serve." Clients with complex barriers to employment, disabilities, or medical conditions, are often grouped under this broad heading. One of the most significant challenges facing states and localities related to serving the hard-to-serve population is identifying the specific conditions and disabilities clients have that may be a barrier to finding and maintaining employment.
In 1999, the U.S. Department of Health and Human Services contracted with the Urban Institute to conduct a Study of Screening and Assessment in TANF/Welfare-to-Work (WtW). The first phase of the study involved a review of the issues and challenges faced by TANF agencies and their partners in developing strategies and selecting instruments to identify substance abuse and mental health problems, learning disabilities, and domestic violence situations among TANF clients. The issues and challenges identified through that review are presented in Ten Important Questions TANF Agencies and Their Partners Should Consider (hereafter referred to as Ten Important Questions). The second phase of the study involved case studies of a limited number of localities to further explore how TANF agencies and their partners responded to the issues and challenges identified during phase one. The findings from the case studies are presented in this report.
Findings are based on discussions held between November 2000 and February 2001 with TANF agency staff and staff of key partner agencies in six localities: Montgomery County, KS, Owensboro, KY, Minneapolis, MN (the IRIS Program), Las Vegas, NV, Arlington, VA, and Kent, WA. Highlights of the insights offered by the case studies are provided below.
The six localities visited represent a diverse mix of locations in which efforts to identify unobserved barriers to employment are merely one aspect of complicated, multi-faceted TANF programs.
Identification approaches utilized by the study sites can generally be described under two headings--formal and informal. Formal approaches include the use of a tool, instrument, or test whereas informal approaches rely on discussion, disclosure of barriers by clients, or observation of behaviors that may suggest the existence of a barrier to employment.
The use of formal and informal identification approaches are not mutually exclusive. In fact, many staff responsible for implementing formal identification approaches reported that they use a tool or instrument as a part of a much larger process that includes informal identification strategies as well.
Few tools have been developed for use with TANF clients or are designed to address the multiple barriers many TANF clients face. While many still seek an instrument that would accurately and reliably identify a wide range of issues faced by TANF clients, the reality is no such tool currently exists, or arguably, may ever exist.
Generally, TANF agencies in the study sites use few validated tools to identify unobserved barriers to employment. However, the limited use of validated tools among TANF agencies does not indicate a general lack of use of tools or instruments to collect information and explore barriers. Partner agency staff who frequently possess greater expertise and formal training regarding barrier identification and are able to utilize a wider range of validated tools to uncover unobserved barriers to employment.
Informal efforts to identify barriers occur throughout the case management process. Each interaction with program staff presents an informal identification opportunity where clients can disclose barriers to employment and staff can elicit disclosure or observe behaviors/characteristics that are indicative of the existence of a barrier. The important question is therefore, how TANF agencies should integrate barrier identification into this multi-step process? The answer to this questions must take into consideration the various steps involved, the staff with whom clients interact at each point in the process, and the TANF policy context.
Staff in all sites reported using informal identification approaches throughout an individual's interaction with the TANF system. These efforts were employed to different degrees across different staff positions, but occurred regardless of the use of a more formal identification instrument or the level of skill or training of the individual staff person. Importantly, even highly specialized staff who possess advanced training related to barrier identification noted the importance of informal strategies.
The majority of staff reported that they believe informal approaches are more effective in uncovering barriers than the completion of a specific screening or assessment tool. However, informal identification efforts rely heavily on clients to disclose a barrier to employment or to exhibit a behavior indicative of a barrier. Reliance on disclosure and behavioral observations presents a particular challenge when considering unobserved barriers to employment because many clients are unaware of their condition or may not consider their condition/situation a barrier to employment. Alternatively, clients may be simply unwilling to disclose a barrier to their case worker and make efforts to conceal the barrier.
The study sites have attempted to maximize the advantages of both formal and informal approaches by using them in combination with one another and expecting no one effort to uncover all barriers to employment.
As TANF agencies and their partners increasingly focus on efforts to identify unobserved barriers to employment, they must consider the roles different staff should play in the barrier identification process. In doing this, they must decide how to best utilize TANF agency staff and staff of partner agencies in this endeavor. In all of the study sites, TANF case managers play an integral role in initial barrier identification efforts, in many cases creating a new role for these staff. However, case managers' abilities to fulfill barrier identification responsibilities are affected by their other responsibilities, their skills and training, and the size of their caseloads.
The study sites rely on specialized staff to assist in the identification of unobserved barriers to employment to varying degrees. Although TANF case managers bear the primary responsibility for initially detecting the possibility of an unobserved barrier, more specialized workers are responsible for additional assessment or diagnosis. Specialized staff may be social workers employed by the TANF agency or clinicians employed by partner agencies who are co-located in the TANF office. Additionally, in all sites, clients may be referred to partner agencies where specialized staff who have more formal training relating to an unobserved barrier, or experience working with individuals with a particular barrier, are involved in the barrier identification and/or diagnosis process.
Focus groups conducted with TANF clients in each study site indicate that clients give careful consideration to decisions regarding to whom to disclose their barriers, and were generally more comfortable disclosing to specialized workers than staff with responsibility for benefit eligibility determination. Clients are particularly concerned with the possible repercussions of disclosure--including affects to benefits and possible removal of children from the home. Other factors that affect decisions to disclose are the existence of a trusting relationship, understanding the help that is available, and the client's willingness to accept help.
The coordination and sharing of information among the variety of staff and partners involved in identifying and addressing unobserved barriers to employment is a complicated challenge and requires a significant investment in communication and collaboration at multiple levels. The study sites employed two methods of sharing information among staff--case staffings and a team approach. Generally, staffings are intended to offer the opportunity for a variety of staff to pool information regarding barriers, discuss clients' situations, and determine appropriate next steps for a client. In sites utilizing team approaches, information is shared on an on-going basis and supported by an understanding of joint responsibility for a case by all members of often interdisciplinary teams.
Sharing information among the variety of staff involved in barrier identification requires that all involved give special attention to issues of confidentiality. A number of different federal and state laws, as well as regulations, guide the protection of privacy, the confidentiality of records, and informed consent. When asked, staff in all of the study sites appeared familiar with their offices' guidelines regarding confidentiality and information sharing. In some cases, staff of partner agencies appeared more familiar than TANF agency staff with the details of these provisions and the need to obtain informed consent from clients before sharing information with the TANF agency. The experiences of the study sites offers hope that, despite the complexity surrounding issues of privacy and confidentiality, these challenges are not insurmountable and should not prohibit the implementation of proactive strategies to identify and address unobserved barriers to employment.
TANF agencies in the study sites work with a variety of partners to assist with unobserved barrier identification and to provide services to clients once barriers are identified. Key partners include other government agencies, community mental health centers, substance abuse treatment programs, domestic violence shelters and counseling agencies, educational institutions, and others. In some cases these partners have had longstanding relationships with the TANF agency, while in other cases, new partnerships have formed as efforts to expand the identification of unobserved barriers have grown. In all sites, partnerships offer TANF clients access to staff with skills and expertise related to identifying unobserved barriers and, in some cases, barrier specific services. Thus, partners' skills and services complement and supplement services provided by the TANF agency.
Partnerships in the study sites were created in a variety of ways. This variation is in part based on the responsibilities maintained at the state level, as compared to those passed to regional or local TANF offices. In some cases, partnerships grew out of past experience working informally with other organizations within a community's social service system. Overwhelmingly, TANF staff at all levels reported having little difficulty securing services necessary to support efforts to identify and address unobserved barriers. In part this may be a result of the study sites being service rich communities. However, staff commonly attributed this ease to the general availability of TANF funding to purchase or create services.
Forging and maintaining partnerships to provide services to welfare recipients is neither a new nor a simple challenge for TANF agencies. Each of the study sites has faced this challenge and has undertaken different efforts to facilitate partnerships, including taking care to set clear expectations, obtaining support from staff at all levels, and co-locating partners.
In all sites, partners fill multiple roles. Partners typically conduct additional assessment or diagnose a condition and determine the appropriate level or type of treatment or services. In many situations, partners also provide the treatment or services required to address or mitigate barriers. A less formalized although potentially valuable role for partners in some sites is that of educating TANF staff on how to identify unobserved barriers.
The case study sites offer a number of lessons regarding the issues and challenges associated with creating strategies to identify substance abuse and mental health problems, domestic violence situations, and learning disabilities. Perhaps one of the most important findings from the case studies is that the study sites have developed approaches that integrate barrier identification throughout a client's TANF experience rather attempting to identify unobserved barriers at a single point in time. By involving a variety of staff (including staff of partner agencies) and using multiple identification strategies (formal and informal), the study sites have created a variety of opportunities to uncover unobserved barriers to employment while remaining focused on the employment and self-sufficiency goals of welfare reform.
Some welfare agencies that perceive their remaining welfare clients to be hard-to-serve are beginning to rethink their Work First approach. However, the study sites have found ways to maintain a work focus while also incorporating barrier identification strategies. It is important to note that these sites have not reverted to a pre-welfare reform strategy of exempting clients from participation. In all of the study sites, clients may be allowed to engage in non-work related activities in an effort to remove or mitigate barriers. However, these activities are considered a necessary step for a client to ultimately become employable and leave welfare.
TANF clients with substance abuse and mental health problems, domestic violence situations, and/or learning disabilities, will continue to present identification and service delivery challenges to TANF agencies and their partners. The case study sites have made great strides into relatively uncharted territory by developing the identification and service strategies described here. If such strategies are to continue, and new efforts are to be developed, TANF agencies and their partners will require the resources to support staff by maintaining or establishing workloads that facilitate barrier identification efforts, involve specialized staff and/or partner agencies, and provide staff training. If the progress made toward identifying and addressing barriers faced by the hard-to-serve is to be sustained, it will be important for policymakers not to succumb to pressures to reduce funding or limit the flexibility provided to states and localities when considering the reauthorization of TANF in 2002.
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