Serving Welfare Recipients with Disabilities
by Fredrica D. Kramer
Background
Because the Aid to Families with Dependent Children program excused from work those who were ill or incapacitated, or who were caretakers of such individuals—and de facto excused many others considered hard to serve, few agencies now administering TANF (Temporary Assistance to Needy Families) are expert at recognizing or addressing the range of disabilities recipients may present.
A disability is generally defined as a physical or mental impairment that limits one or more major life activities (which could include working). Disabilities can include chronic health conditions that limit employment or require continued monitoring and care, mental health problems and the effects of drug and alcohol abuse, permanent physical impairments that require workplace modifications, and learning or developmental disabilities that limit access to employment. The following discussion deals principally with physical and mental impairments that may pose challenges to gaining or sustaining employment. The reader is directed to earlier WIN Issue Notes, in particular to an analysis of options for serving the hard to place (Kramer, 1998).
Though an emphasis on employment is gaining currency in social insurance systems, policies across programs for persons with disabilities are often divergent, and expose a tension between the historical perspective of protective exemption from work requirements and increasing advocacy for the right to work. For example, the Supplementary Security Income (SSI) program aims at assuring income in the absence of work, and hence restricts eligibility to a specific and medically determined inability to work. The Americans with Disabilities Act of 1990 (ADA) aims to accommodate individuals’ desire for work and thus requires individualized rather than generic determinations of work capabilities in order to make services available. Thus TANF agencies may not find clear guidance from other programs for defining disabilities, setting work requirements or setting time limits for assistance.
TANF requires work participation after two years of receipt of benefits, and allows exemptions to the lifetime limit to benefits to only 20 percent of the caseload. Recipients with disabilities who now must or want to work may seek or require special diagnostic and other services in order to participate. Moreover, the convergence of TANF, the new Workforce Investment Act, and ADA make it harder for TANF agencies to divest themselves of the responsibility of serving individuals with disabilities, though they may need experts to help serve them. Interagency collaboration has historically been difficult. TANF agencies will now need to become effective advocates for their clients as they work with a range of service providers, including vocational rehabilitation (VR), mental health agencies, and community colleges, and as they encourage employers to accommodate sometimes challenging clients who need or want to work. Finally, policies will need to reflect both the desires of persons with disabilities to work and a recognition that certain individuals may still have severe work limitations, and may require long term cash and services.
Policy Issues
Most TANF agencies are at the early stages of developing strategies for individuals with disabilities. Problems of identification and need for special services warrant that they seek close collaboration with experts. Exploratory discussions internally and with other service providers—parallel agencies as well as non-governmental institutions—ought to begin with the following issues in mind.
Who should be considered disabled within the TANF context? States have wide discretion in defining disabilities, and programs need to consider a broad range of conditions, as mentioned above, that may not fall under SSI or ADA limitations but may present barriers to employment and long term self sufficiency.
Controversy surrounds the nature and significance of certain disabilities. For example, special learning needs may cover a broad range of disabilities, including learning disabilities (LD), mild mental retardation (MMR), slow learning, and below average IQ or low basic skills. The relationship between apparent LD, low IQ, MMR, and developmental disabilities is not always clear. LD, associated with impairment of the ability to process information and often associated with higher than average intelligence, is largely undiagnosed, and individuals with LD may be dismissed as slow learners. Adults with mental retardation may be able to work and, as with LD, the condition may be unrecognized by TANF staff. Developmental disabilities, associated with functional impairments including cerebral palsy, autism, blindness and MR, may or may not be obvious to TANF staff.
Mental health issues can be narrowly defined to meet diagnostic criteria for affective disorders that seriously interfere with one of more aspects of daily life, or more broadly defined to include symptomatic problems indicative of mental illness or of other difficulties in a recipient’s life. Different screening techniques will reveal with varying precision the presence or risk of mental health problems. Problems such as anxiety, depression, and behavior problems may be observable at intake or in job preparation activities, and by caseworkers who are astute, or by incorporating simple questions into intake and follow-up protocol to enable caseworkers to seek further expert assistance.
Identifying disabilities with certainty is likely to be a long, even elusory, process. States might begin by examining the number and kinds of medical exemptions in their current caseload, and have caseworkers, physicians, or medical review teams review those cases. Or they might use simple screening tools on a sample of their caseload, or survey caseworkers’ experiences, to determine what is knowable currently and what tools might be used to learn more about the prevalence and nature of disabilities in the current caseload. States might also explore modifications to their administrative data systems to help identify and track families with disabilities, particularly those with exemptions.
What are the obligations of TANF agencies to serve persons with disabilities? Section 504 of the Rehabilitation Act of 1973 prohibits recipients of federal financial assistance from discriminating against an individual with a disability. The ADA entitles individuals to certain accommodations in order to access services, and to protections from improper treatment. It also protects individuals from discrimination who are improperly regarded as disabled. ADA uses a strict definition of disabilities, including physical or mental impairments (or a record of impairment) that are not short term, that exist without regard to mitigating medication or other aids, and that substantially limit a major life activity, such as caring for oneself, performing manual tasks, walking, seeing, speaking, breathing, learning, and working.
Under ADA, public entities cannot discriminate against individuals with disabilities in the ways in which they screen, determine eligibility, or deliver services, and they must make "reasonable modifications" in order to avoid discrimination, unless such modification would fundamentally alter the nature of the program or service. ADA also applies to public and private employers of 15 or more employees, and (with some exceptions including religious organizations) to private education, training, employment referral and child care programs. Executive Order 13078, signed March 13, 1998, calls on programs that work with welfare clients to incorporate "reasonable accommodations" into education, job training, and employment settings, which could include use of tape recording for educational instruction and the GED, and receiving oral instructions at work, among other options.
ADA requirements with respect to TANF are not yet fully understood and the litigation is mixed (see Semmel and LaCheen, 1998, for a review of related litigation). But litigation in New York, now on appeal, successfully challenged workfare assignments that exceeded recipients’ limitations (Mitchell v. Turner). Subsequent state law retains those protections and more (see Welfare Law Center (b)). A Massachussetts suit now in the courts (Ramos v. McIntire) seeks to assure that screening, instruction and other services in education and training programs adequately adapt to recipients with learning disabilities consistent with ADA standards (contact Ruth Bourquin, 617-357-0019).
Irrespective of litigation, states might review how well current procedures can accommodate the identification and treatment of recipients with disabilities. Indeed, ADA requires that public entities undertake a self evaluation to assess whether policies and procedures are consistent with the Act. In addition to physical accessibility as required by law, programs should consider the possibilities and limitations of application procedures, assessment, job search and other work assignments as they would be experienced by persons with disabilities. For example, job search before application and before assessing for disabilities that might impede such activities, inadequate assistance in application for those with cognitive impairments or emotional illness, or categorically excluding families with other disability insurance income from TANF merit evaluation (see Silverstein, et. al, 1998). Skill assessments prior to work assignments should arguably screen for disabilities sufficient to avoid inappropriate assignments on the one hand and assure access to full service assistance on the other. States may also be obligated to extend ADA protections to persons in community service jobs, and to offer employment-based assistance if it can be reasonably provided.
How should the work requirement be applied to persons with disabilities? Policies need not prejudge whether and under what conditions individuals can work, though, as noted above, activities to fulfill the work requirement need to reflect the ability of individuals with disabilities to comply, particularly those with cognitive, emotional, or physical impairments.
But states may have greater flexibility than generally thought in applying the work requirement. Thirty states (Thompson, et al., 1998) have broadened their work participation policies to include persons with disabilities, or require universal participation. Other states have "suspended" or "deferred" the work requirement while services such as substance abuse or mental health counseling are being obtained. Broadening the definition of work participation can allow a variety of activities that would advance an individual toward self sufficiency (e.g., participating in substance abuse treatment, attending parenting classes, applying for SSI). Such policies may afford access to assessment and services for recipients who have historically been passed over, and some states have broadened participation explicitly to assure services to families who could face the end of benefits in precarious circumstance. Such activities may not satisfy the federal definition of allowable work activities, but states can use their maintenance of effort (MOE) funds to pay for such services. Community service assignments and workfare, which are within federal restrictions, may also afford creative approaches to the work requirement for those with disabilities.
Currently states are being granted substantial relief, based on their caseload decline, from mandated work participation rates. They are thus able to meet federal requirements for work participation as federally defined, and have greater flexibility to devise other activities to serve those with disabilities. Above all, states should consider the costs of enhancing services and the capacity of providers to deliver them, in order that those subjected to the work requirement can be served adequately.
How should caretaker responsibilities for disabled children or other household members be treated? Most states (Thompson, et.al, 1998), are applying the same participation requirements and time limits to caregivers as to those who are themselves disabled, though how to apply exemptions to the time limit is still evolving. States that require broader participation (15 states require universal participation) may count caregiving as participation, or may restrict allowable caregiving to a child or spouse (Hawaii) or just a child (Georgia). Staff may attempt to find alternative care arrangements, though this may be extremely time consuming, with the services hard to find and costly.
Though TANF recipients with caretaker responsibilities may find it hard to work outside the home, agency policy ought to consider the long term prospects for the family if the household head does not receive employment related services. Some states may assist caregivers to engage in work related activities that can be accomplished from home (e.g., telemarketing) and thus enhance their employment prospects when benefits are ended. Caseworkers will need to balance the availability and costs of caretaker services and the long term needs of the family, and collaborate with the client on objectives and implementation.
How will sanction policies affect those with disabilities? Enforcing work participation without adequate accommodations may subject recipients with disabilities disproportionately to sanctions. Many of the hard to serve may have undiagnosed disabilities that put them at risk for sanction. For example, some families may have mental health issues and other domestic difficulties that cause them to be sanctioned. Indeed, aspects of low self esteem, depression, and other mental health issues, and substance abuse, may play an explicitly interactive role with the ability to cooperate, and therefore result in failure to comply with program requirements.
Programs will want to assess routinely who is being sanctioned and why, to reassess families under threat of sanction in order to avoid sanction where possible, and to develop strategies for continued monitoring and support for families whose failure to comply was based in mental health or related disabilities. Monitoring, however, may pose both a threat to privacy and a potentially dangerous irritant to families with serious domestic strife. TANF agencies will need to devise models for interaction that make help available rather than obligatory or intrusive.
Should (any) recipients with disabilities be exempted from the time limit? Twenty-four states (Thompson, et. al, 1998) have exempted persons with disabilities (using a variety of definitions) from the time limit, particularly when the state time limit is shorter than the federal limit. A few already plan to use state MOE dollars to support those in need of assistance beyond 60 months (e.g., Minnesota, Maine), in its effect expanding the number who are exempted from time limits. Many states find it too early to decide about the use of hardship exemptions from the federal time limit while caseloads are declining and they do not know who may remain beyond 60 months and what services they will need (Thompson, et. al, 1998).
TANF programs will want to be mindful that clients who are exempted from time limits could be neglected for needed services. Programs will also need to develop policies to assure that clients are reassessed in a timely manner for changes in conditions, to assure appropriate transfers (e.g., from drug treatment to education or employment services), and to monitor families in which emotional or other conditions make them vulnerable to additional problems.
How can TANF agencies get needed expertise to screen, diagnose, and serve those with disabilities? Some agencies are training caseworkers to administer new screening tools, particularly for LD, on which to base referrals to specialists. The development of effective mental health screening tools for welfare agencies is much needed. Some tools, such as a four-item scale based on the Diagnostics and Statistical Manual of Mental Disorders (DSM) for measuring risk of clinical depression, may be transferable for use in the welfare office (see Johnson and Meckstroth, 1998).
Even if special tools and training are provided to caseworkers to conduct initial screening, more in-depth diagnostic assessments and vocational evaluations will likely be needed, using clinical psychologists or other experts. Similarly, TANF agencies can offer enhanced case management where disabilities, particular around mental health, warrant closer monitoring, but they will also likely need experts to design screening and monitoring protocols, provide additional diagnoses, and deliver needed services. No matter who is responsible for assessment and case management, staff training should assure that TANF line workers or other experts are aware of the interaction of issues such as domestic violence, housing needs, and substance abuse, with mental health and other disabilities, and that they are sufficiently knowledgeable about referral sources and appropriate accommodations in education, training and employment settings.
Collaboration exposes historical differences in philosophies between TANF and, for example, SSI, certain mental health programs, and vocational rehabilitation—which tolerates long duration of training and employment services not consistent with TANF’s time limits. Successful collaborations are, however, emerging, for instance to allow VR participation to satisfy the TANF work requirement. TANF agencies will want to facilitate potentially ongoing dialogues to share agencies’ policies, understand their nuances and create new arenas for collaboration. TANF agencies may want to engage nongovernmental and advocacy groups in such discussions to expand their own perspectives and the ground for collaboration.
How will identification be treated with respect to prescribing services and sharing information? The ability to diagnose with precision many mental health, behavioral, and emotional disturbances is uneven at best. The convergence of substance abuse and other problems is not well understood, and complicated by the self reporting of much substance abuse data. In addition, the ability to function in the workplace for many substance abusers and others with psychological disorders is not universally agreed upon, and many conditions might be successfully managed with ongoing services and without employer recognition or involvement.
Exposure of mental health or substance abuse problems may raise other issues that TANF agencies are ill equipped to manage, for example, problems due to labeling, misdiagnosis and inappropriate assignment on the one hand and an obligation to treat on the other. Strategies that aim at inclusion, with a wide variety of service options into which individuals can self sort, may mitigate some of the labeling issues associated with refined assessment and diagnosis.
The potential for misidentification and stigmatizing, the risk of client noncooperation, and added demands for follow-up may also create concerns for already burdened eligibility workers and case managers. TANF programs that have specially trained workers or contract specialists in-house, or who co-locate with mental health, VR, or substance abuse treatment providers may increase the opportunities for collegial or team consultation on individual cases, reduce the need for formal referrals, and enhance the chances for cooperation of reluctant clients.
In all cases, protection of confidentiality, particularly across jurisdictional lines and between public agencies and employers, should remain a critical concern as information will inevitably have to be shared with a wider set of actors. Concern about creating misleading or inaccurate personal histories ought to remain the backdrop behind all protocols for screening and referral that agencies develop.
How can states fund special services for recipients with disabilities? Special services for job preparation, ongoing treatment such as mental health counseling, or new venues for employment such as supported work, may not be widely available. TANF agencies might try to leverage their funds to help others expand their coverage to TANF recipients. For instance, VR must give priority to the most severely disabled and serves only a small fraction of eligible clients. In addition, many states cannot meet matching requirements that would enable them to fully access federal funds. Mental health and TANF agencies have partnered with VR to help them meet the federal match and thereby access additional funds to serve TANF recipients. Such agreements have also allowed TANF recipients who do not meet VR criteria to receive services.
In addition, 10 percent of TANF funds (reduced to 4.5 percent in 2001) may be transferred to the Social Services Block Grant, state MOE funds may be used for alcohol and drug treatment, and Welfare-to-Work funds may be used for substance abuse treatment. TANF funds may not be used for medical services, but a strict interpretation of the proposed federal rules would apply the ban only to inpatient acute care services, medications, primary health services for those in treatment and drug testing, and not to counseling and case management for substance abusers. Costs for learning disability assessments may be partially offset by coordinated funding arrangements with Medicaid.
Is SSI being fully utilized for income support or the cost of services for disabled children or adults in TANF-assisted families? States have at times been aggressive in attempting to shift cases from TANF to SSI in order to provide disabled low income children both income and services. It may now be useful to revisit the possibility of SSI for other household members, particularly in order to pay for needed long term services. SSI defines disability as the inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment expected to result in death or that has or will last more than 12 months. Enhanced capabilities to identify persons with disabilities might increase the potential use of SSI for long term coverage. On a related issue, some states have elected to include the SSI recipient in the assistance unit and to count SSI benefits of a child in computing the TANF grant. While this may reduce state outlays for TANF benefits, it may make families, particularly in low benefit states, ineligible for cash assistance and other supports that would move them toward self sufficiency in the long run.
How can TANF agencies better inform employers about the problems and opportunities of working with those with disabilities? Employers may have limited understanding of the nature of disabilities and their effects on employment, productivity and health coverage. Small employers, for example, may fear higher insurance rates if they hire individuals with disabilities, though such individuals may actually exemplify low absenteeism and long-term commitment. Information on ways to configure job structure, work hours, and work sites, and ensure health coverage and continuing assistance on the job may also help employers hire those with disabilities. TANF agencies can work with vocational rehabilitation and mental health professionals with greater experience in this area. Agencies may also want to engage advocacy groups to help devise informational materials and ways to approach employers.
Research Findings
National data suggest disabilities in the welfare population may be substantial. Using three national surveys, Loprest and Acs (1996) found nearly 30 percent of AFDC families had a woman or child with some disability, and about 20 percent had a disabled mother or severely disabled child. Over 10 percent reported a serious disability (impeding basic functions such as dressing, eating or getting around the house) and another nearly 10 percent had difficulty with an "instrumental activity of daily living" (seeing ordinary newsprint, hearing or understanding speech, certain ordinary household tasks). Between 16.6 and 19.2 percent of AFDC mothers had a work limitation. A survey of California AFDC households found 43 percent had mothers or children with disabilities or chronic health problems (Meyers, et al., 1996). Loprest and Acs also found high health care use among AFDC women. In the one year measured, 10 percent had hospital stays, nearly 9 percent had 16 or more doctor visits, and 7 percent were confined to bed for over 30 days.
Estimates of mental health problems vary, in part depending on definitions and survey techniques. One review finds estimates from national surveys range from 6 to 23 percent using narrowly defined measures of affective disorders and up to 39 percent using indicators symptomatic of depression (Johnson and Meckstroth, 1998). A survey since welfare reform of recipients not deferred for a disability or otherwise (Danziger, et. al, 1998) found 27 percent met the criteria for major depression, 15 percent for post-traumatic stress disorder (PTSD), and 7 percent for generalized anxiety disorder. Another literature review (Kalil, et. al, 1998) reports 42 percent of AFDC recipients (compared to 20 percent of nonrecipients) in the 1992 National Longitudinal Survey of Youth (NLSY) were at risk for clinical depression, with similar findings from JOBS evaluation data. Traumas from rape, domestic violence and sexual molestation, it is noted, may put many at risk of PTSD, which is three times higher among low income women than the general population.
The 1994-5 National Household Surveys of Drug Abuse, which has information on psychiatric disorders, welfare use, and substance abuse, found about 19 percent of welfare recipients (compared to 15 percent of nonrecipients) qualify for a diagnosis of psychiatric disorder: major depression, generalized anxiety disorder, panic attack, and agoraphobia or one of three other psychiatric disorders. A psychiatric disorder and crack/cocaine raised the odds of welfare use significantly.
Learning disabilities are indicated by a disjuncture between potential achievement (as measured by IQ) and measured achievement. The Washington State Learning Disabilities Initiative found 54 percent of JOBS participants had special learning needs, with 35 percent learning disabled, 14 percent slow learners (IQ of 70-80), and 5 percent showing mild mental retardation (IQ below 70). A similar initiative in Kansas found about 30 percent of its AFDC caseload with LD and about 26 percent with IQs at or below 80. Some researchers argue that gender bias has made girls less identified for LD and less likely to receive needed special education, which in turn leads to a variety of problems including school failure and teen motherhood, and may carry over into adulthood creating overrepresentation of LD in the welfare population (Young, et al., 1997). Individuals with low literacy levels due to undiagnosed LD, a common problem, may be siphoned off into adult basic education without occupational training (Brown, 1998), or drop out of training because their needs are unmet (Gerber and Reiff, in Johnson and Meckstroth, 1998).
Relation to work. Children in low income families are likely to have more health problems, health problems in childhood may have residual effects in adulthood resulting in more chronic or handicapping conditions, and families with major health issues are likely to have a harder time maintaining employment. Loprest and Acs (1996) found between 11.1 and 15.9 percent of AFDC children had some activity limitation, almost 4 percent had one or more chronic conditions, and over 14 percent of school-age children had some special need (special classes, or limitations or inability to attend school).
In another analysis using NLSY and National Medical Expenditure Survey data, more than one in three families faced a family illness of 2 weeks or more each year, 28 percent had no sick leave in the five years observed, 36 percent of the mothers of children with chronic conditions had no sick leave while they were employed, and 38 percent of those who lived in poverty had no sick leave (Heymann, Earle, and Egleston, 1996). In the NLSY, 59 percent of mothers who returned to work after 5 years on welfare lacked paid sick leave and 32 percent had neither sick leave nor paid vacation, compared to 30 percent and 15 percent for working mothers never on welfare (Heymann and Earle, 1998).
There is evidence that, at least in the AFDC environment, welfare recipients with disabilities were unlikely to leave welfare for work. In one NLSY analysis (Pavetti, 1997) 63 percent of those with severe barriers worked less than 25 percent of the time or not at all. Over a third of disabled adults, according to a recent Harris poll, lived in households with income of $15,000 or less, and only 29 percent of disabled individuals 18-64 worked (72 percent said they preferred to work), compared to 79 percent for the nondisabled (National Organization on Disability, 1998).
There is some evidence that vocational rehabilitation programs for both physical and emotional disabilities can result in significant gains in employment. Although the costs of assessments can vary greatly, the response to a diagnosed learning disability, for example, can be low cost tutoring or mentoring, modifying instructional materials, and combining basic skills instruction with functional occupational skills training (Johnson and Meckstroth, 1998).
Innovative Practices
Getting needed expertise for client assessment and delivery of services.
Vermont has developed a memorandum of understanding between TANF and VR, perhaps a useful model for other states, to improve a formerly hit or miss referral process, provide cross-training of staff, and negotiate individualized employment plans that respect differences in policies. Referrals to VR are based on simple questions about whether an applicant’s or recipient’s condition impacts her ability to work, is longstanding (over a year) and whether she is willing to be assisted by VR. For those not referred, REACH UP (formerly JOBS) case managers use an extensive set of questions provided by VR, using functional loss indicators and a severity continuum, to assess areas of dysfunction and potentially to refer to VR. Referral can result in exemptions from the work requirement up to a year or indefinitely. Contact Steve Gold, 802-241-2834.
Kansas reviewed the file records on a sample of their caseload with medical exemptions, and found about a quarter with mental illness, about a quarter with muscular or skeletal disabilities, and the remainder with other conditions including neurological, respiratory conditions or diabetes. Staff are consulting with the disability community, and calling in all cases for possible referral to vocational rehabilitation and to put supports in place to permit work participation. TANF and VR, under the same umbrella agency, commonly co-locate services, and staff can share intake and assessment functions. They have created a formal component to allow VR participation to meet the TANF work requirement. The state is also pooling staff and funding from TANF, Child and Family Services, and Alcohol and Drug Services to pair intensive case management with child protective service workers and improve treatment and employment outcomes. Contact Katy Evans, 785-296-0147.
Maine has contracted with three private non-profit agencies (Maine Medical Center, Goodwill Industries, and BDL Rehabilitation, Inc.) to each cover a region of the state, and assess, refer to other collaborating agencies, or place TANF recipients with disabilities, including learning disabilities, domestic violence, and substance abuse. The contractors have helped train TANF staff who do basic screening, and a good working relationship between TANF and contractors supports the referral process. Because contractors offer a greater level of service with one-on-one attention over a sustained period of time, they relieve otherwise overburdened staff and may alleviate some client resistance to referrals. Because Maine is within federal participation requirements, it has flexibility in applying the requirement to recipients with disabilities, and state law allows families that have complied with program requirements (fewer than three sanctions) to continue to receive benefits beyond 60 months using state funds. Contact Stephen Telow, 207-287-3309.
Florida’s WAGES PLUS, under contract to the University of Florida, will serve TANF applicants with substantial barriers to employment. Preliminary data from the instrument used by TANF staff to screen applicants found about a quarter had a variety of serious anxiety indicators, a quarter revealed serious depression (two or more weeks), and a quarter were unable to carry out daily activities due to family or personal health problems. The project will ultimately have a team of social workers, case managers, psychologists, and job developers, with access to local medical, drug treatment and psychiatric facilities for services. They credit positive client response to aggressive outreach, including home visits to all those served. Contact Leslie Clarke, 352-392-8254.
Washington State began a pilot in 1994 to develop a brief screening tool to enable case managers and social workers to identify AFDC recipients with learning disabilities. The project will train staff to use the tool, and will work with vocational rehabilitation, social service agencies and community colleges to improve referral, use alternative testing, instruction and library formats, and assist clients to access information and develop strategies to accommodate their disabilities—including developing necessary social skills for employment, pursuing educational activities, and requesting accommodations in the workplace. Contact Allen Shanafelt, 360-413-3243.
Illinois, on a pilot basis in two locations, will prescreen TANF recipients for LD using the 14 question inventory developed in the Washington State initiative, and refer for hearing, vision testing, and adult education. Those referred will be given an eligibility assessment using the TABE (Test for Adult Basic Education). Those who score between 3rd and 8th grade levels and indicate mild to severe LD may be eligible for a four-month, work-based component combining counseling, education and job experience, including two months of soft skills training and two months of job shadowing and internships. Contact Sue Barauski, 847-803-3535.
Several more states (e.g., KS, RI, MN, WI, MO) have begun LD initiatives, many of whom have borrowed aspects from the Washington experience. And seven states have Welfare-To-Work grants to develop models for LD (AK, CA, FL, OH, NM, NJ).
Maryland screens every TANF applicant for potential referral to SSI. They are particularly concerned with expanding access to SSI for children, in TANF families or elsewhere, in part to stem the use and cost of foster care. Applicants identified with a disability must have a doctor complete a medical form, and those with expected long-term disabilities are referred to a state-funded contractor (Disability Entitlement Advocacy Program (DEAP)) for assistance in applying for SSI. DEAP continues as long as the SSI determination is pending and will provide an attorney to support an appeal. During this time the TANF time clock stops, the case is funded with state MOE dollars in a separate state program, and other services may continue. For disabilities that would not appear to meet SSI eligibility criteria TANF time limits and work requirements apply. The state is training cases managers to access the mental health system with representatives of that system and have access to a toll-free telephone number to make referrals. Contact Richard Larson, 410-767-7150.
Models for supporting employment
New Jersey has had a 10-year collaborative between its VR and mental health agencies to refer individuals with severe mental illness to a non-profit Supported Employment contractor in each of its 21 counties. The contractors market themselves to prospective employers as an employment service, and individuals may choose whether or not to disclose their condition to an employer. Depending on that preference, contractors may work with the employer to develop jobs of mutual benefit with the promise of continued support on or off site, or clients may receive continued support off site. Services can include including vocational assessments, life skills training, and service referrals, and continued supports include a variety of counseling and job coaching interventions that can last for as long as needed. Although there is no formal arrangement with the TANF agency, perhaps a third of the clients have been welfare recipients. Contact Steve Fishbein, 609-777-0708.
KANDU Industries, a non-profit rehabilitation center for persons with disabilities, is now handling all TANF Work First participants in Ottawa County, Michigan. Its work centers provide minimum wage jobs, generally for 25 hours/week up to 6 weeks, for those who do not find employment after a two week job club, with continued supportive services using community mental health or other providers and TANF funds. Its largest product line is picture frames, though products for the 60-70 companies with whom it contracts include assembly, packaging, collating, and quality control inspection, and its products and services are competitive in both cost and quality. Though the program may make some modifications in jobs (e.g., different tools, quieter work stations), it credits staff assistance for generally affording the necessary accommodation to an individual’s special needs. Contact Peg Beall, 616-355-3214.
The Corporation for Supportive Housing (CSH), in eight sites around the country, was begun to create permanent housing with on-site services for homeless single individuals with chronic disabilities (e.g., mental illness, substance abuse, HIV infection, chronic housing instability or homelessness). It is in the early stages of expanding its work (in New York City, Illinois, Minneapolis, San Francisco Bay Area) to support hard to serve, but unlikely to be exempted, families on public assistance. CSH projects use non-profit housing developers and social service providers, state and local financing for capital and operating costs, and some foundation funding. CSH’s "Next Step Jobs" is a housing-based employment initiative. Some projects have hired clients directly by expanding the number of in-house jobs. Others have profitable businesses that employ residents directly (e.g., bakery, landscaping, coffeehouse, sporting goods, thrift store).
The housing-based model is ideal for people with disabilities because it offers the possibility for bundling social and employment services, for "blended management" between social service and property management staff (rather than using adjunct social service professionals, as traditionally done), and in generally stable, well managed settings. Place-based employment strategies allow for long term relationships, involvement of a network of individuals beyond the client and staff, and a critical mass of work participation and high expectations that reinforce work norms—often essential to individuals with severe barriers to employment. The program finds that part time or temporary employment is common among people with mental illness, that long term services are necessary for individuals who often follow a circuitous path to employment, and that residents with disabilities need services that cut across traditional service lines. Contact John Weiler, 212-986-2966, ext. 234.
Rhode Island offers comprehensive, unlimited physical and mental health benefits (including substance abuse coverage), under Medicaid waiver, to former AFDC recipients with incomes up to 250 percent of the poverty level and their children. For those with serious or persistent mental illness, its community mental health system offers coverage from outpatient to hospitalization, irrespective of TANF eligibility. In addition, the Department of Mental Health has run on a pilot basis a supported work program for adults with serious mental illness, emphasizing placement within a month of entry, and continued support on the job and through inevitable job cycling, using intensive staff services. The program reports over 50 percent of its cases are able to maintain employment. Contact Dan McCarthy, 401-462-6036.
For More Information . . .
RESOURCE CONTACTS
PUBLICATIONS
Yellow Pages: Handbook for Confidentiality in Social Services Collaborations. State of Oregon. October 1998. http://www.hr.state.or.us/ A guidebook on protocols for cross-agency collaboration.
Young, Glenn, H. Jessica Kim, and Paul J. Gerber. Gender Bias and Learning Disabilities: School-Age and Long-Term Consequences for Females. Unpublished, 1997, available through National Institute for Literacy, 202-632-1042.
The Welfare Information Network is supported by grants from the Annie E. Casey Foundation, the Charles Stewart Mott Foundation, the David and Lucile Packard Foundation, the Edna McConnell Clark Foundation, the Ford Foundation, the Foundation for Child Development, the McKnight Foundation, the Woods Fund of Chicago, and the Administration for Children and Families, U.S. Department of Health and Human Services.
