Resources
                                                         For Welfare Decisions
Vol. 7, No. 10                                                                                                                      August 2003
Engaging and Serving TANF Recipients with Depression
 
Research has demonstrated a higher prevalence of depression among low-income individuals and recipients of Temporary Assistance for Needy Families (TANF) than among the general population. Research also suggests that depression can be a significant barrier to employment, can affect an individual’s ability to comply with TANF requirements, and can affect how an individual addresses other barriers to work and self-sufficiency. Depression may even reduce the effectiveness of interventions designed to improve education and employment (Lennon et al. 2001). Children of low-income parents with depression can also suffer. Children of mothers who are depressed are at greater risk for poor outcomes in many areas (Ahluwalia, McGroder, Zaslow, and Hair 2001).
 
Given the relatively high rates of depression among welfare recipients, the effects of depression on employability and child outcomes, and the possibility of increased TANF work requirements in the near future, the mental health needs of welfare recipients will likely be a priority for program administrators and policy makers. Efforts can be made to identify, engage and provide services to TANF recipients with depression. States have used many strategies including, but not limited to, incorporating screening and assessment procedures into the intake system, collocating mental health staff in TANF offices, referring recipients to outside mental health treatment providers, assisting recipients with applying for Supplemental Security Income (SSI) and Medicaid, and following-up with non-participants or those at risk for being sanctioned.
 
Recipients with depression may require more labor- and resource-intensive strategies to involve them and keep them engaged in activities, which can be difficult in the current economic climate. However, states can use a variety of funding sources to provide treatment and services to those with depression including state and general funds; Medicaid; the Community Mental Health Services Block Grant; Temporary Assistance for Needy Families (TANF) monies for non-medical services, supports and employment-related activities; and state maintenance of effort (MOE) funds under TANF for medical and non-medical services (Golonka 2001). This Resources highlights publications and other resources that provide research and information on serving TANF recipients who suffer from depression. For more information on this topic, visit the Welfare Information Network’s page on Mental Health at http://www.financeprojectinfo.org/win/hard-mental.asp or Hard-to-Serve Recipients at http://www.financeprojectinfo.org/win/hard.asp.
 
Publications and Electronic Resources
 
Ahluwalia, Surjeet K. et al. Symptoms of Depression Among Welfare Recipients: A Concern for Two Generations. Washington, D.C.: Child Trends, Inc., December 2001. Available at
http://www.childtrends.org/PDF/Research _Brief_Depression.pdf.
 
Brown, Rebecca. Addressing Substance Abuse and Mental Health Problems Under Welfare Reform: State Issues and Strategies. Washington, D.C.: National Governors Association, Center for Best Practices, June 2001. Available at http://www.nga.org/cda/files/1999SUBABUSE.pdf.
 
Derr, Michelle K., Sarah Douglas, and LaDonna Pavetti. Providing Mental Health Services to TANF Recipients: Program Design Choices and Implementation Challenges in Four States. Washington, D.C.: Mathematica Policy Research, Inc., August 2000. Available at
http://www.jcpr.org/wpfiles/derr_douglas_pavetti_SRI2001.pdf.
 
Goldberg, Heidi. Improving TANF Program Outcomes for Families with Barriers to Employment. Washington, D.C.: Center for Budget and Policy Priorities, January 2002. Available at http://www.cbpp.org/1-22-02tanf3.pdf.
 
Knitzer, Jane. Promoting Resilience: Helping Young Children and Parents Affected by Substance Abuse, Domestic Violence, and Depression in the Context of Welfare Reform, Children and Welfare Reform, Issue Brief 8. New York, NY: National Center for Children in Poverty, March 2000. Available at http://www.nccp.org/media/cwr00h-text.pdf.
 
Kramer, Fredrica. Screening and Assessment for Physical and Mental Health Issues that Impact TANF Recipients' Ability to Work. Washington, D.C.: The Finance Project, February 2002. Available at http://www.financeprojectinfo.org/Publications/physicalandmentalissuenote.htm.
 
Lennon, Mary Clare, Juliana Blome, and Kevin English. Depression and Low-Income Women: Challenges for TANF and Welfare-to-Work Policies and Programs. New York, NY: Research Forum on Children, Families and the New Federalism, April 2001. Available at http://www.researchforum.org/newsletter/Depression410.pdf.
 
Lewis, Dan A., Bong Joo Lee, and Lisa Altenbernd. Mental Health & Welfare Reform: What Facilitates Employment Among Those with Depression? Illinois Families Study, Policy Brief  No. 7. Evanston, IL: Northwestern University, Institute for Policy Research, October 2002. Available at http://www.northwestern.edu/ipr/research/depression.pdf.
 
O'Connor, Jenn. Strategies States Can Use to Employ Persons With Mental Illness. Washington, D.C.: National Governors Association, July 2003. Available at http://www.nga.org/cda/files/0703MENTALILLNESS.pdf.
 
Richardson, Phil. Depression and Other Mental Health Barriers Among Welfare Recipients - Results from Three States. Reston, VA: Maximus, 2002. Available at
http://www.cortidesignhost.com/maximus/cpss/Depression_and_Other_Mental_Health_Barriers_Among_Welfare_Recipients.pdf.
 
U.S. Department of Health and Human Services, Office of the Inspector General. State Strategies for Working with Hard-to-Employ TANF Recipients. Washington, D.C.: U.S. Department of Health and Human Services, Office of the Inspector General, July 2002. Available at
http://oig.hhs.gov/oei/reports/oei-02-00-00630.pdf.
 
Resource Contacts
 
·         California Institute for Mental Health, 916/556-3480; or visit http://www.cimh.org/.
·         Center for Mental Health Services, Substance Abuse and Mental Health Administration, U.S. Department of Health and Human Services, 301/443-0001; or visit
http://www.samhsa.gov/centers/cmhs/cmhs.html. 
·         Judge David L. Bazelon Center for Mental Health Law, 202/467-5730; or visit
http://www.bazelon.org/.
·         MDRC, David Butler, 212/532-3200; or visit http://www.mdrc.org/.
·         National Association of State Mental Health Program Directors, Andrea Fiero, 703/739-9333; or visit http://www.nasmhpd.org/.
·         National Governors Association, Center for Best Practices, Susan Golonka, 202/624-5967; or visit http://www.nga.org/special/1,1260,C_MINI_WEB_SITE^D_1695,00.html.
·         National Mental Health Association, 703/684-7722; or visit http://www.nmha.org. 
·         President’s New Freedom Commission on Mental Health, 301/443-8956; or visit
http://www.mentalhealthcommission.gov/.
 
What States and Localities are Doing
 
Florida. In the state of Florida, the Department of Children and Families (DCF) administers most of the state-funded mental health treatment services for children and adults using TANF funds to contract with service providers. The state administers and coordinates mental health and substance abuse services outside of the welfare and workforce development systems. District TANF specialists manage mental health and employment services locally and contract with mental health and substance abuse treatment providers in each community. All mental health services are available to TANF recipients and those at risk for involvement with TANF. The agency also uses TANF funds to hire outreach staff to identify clients and use a standardized screening tool to determine if they need mental health services. The outreach workers link clients to providers funded by Medicaid or to the TANF-funded contracted providers. Outreach services are provided at community resource centers, public housing communities, one-stop centers where providers are co-located, and through traditional community grassroots engagement. Florida has extended eligibility for services to non-custodial parents and other low-income families with an income up to 200 percent of poverty. The state has also developed community outreach campaigns to inform partner agencies and clients who are receiving services outside of the welfare system about the available services. For more information, contact Kim Finch-Kareem, Florida Department of Children and Families, 850/410-1187.
 
Nebraska. Nebraska Employment First (the state TANF program) staff use the Employment First Screening and Assessment Form to identify and assess clients’ barriers to work and self-sufficiency. A work group including two Employment First program specialists and eight local office staff convened in early 2001 to develop the tool. The work group looked at assessment tools used by other states and worked with their regional Administration for Children and Families (ACF) office and with the Substance Abuse and Mental Health Services Administration to gather information and input. In the fall of 2001, a pilot test of the form was performed in two state service areas. During this time, a guide for the form was developed to inform caseworkers and case managers about the assessment process, the form, and its uses. The form was implemented statewide in January 2002 and, along with the accompanying guide, was incorporated into training for new staff. The form covers 17 life domains, including mental health, and is designed to be completed in approximately 45 minutes. The form is an integral part of the process of designing clients’ self-sufficiency plans. All clients must go through a formal orientation, followed by the screening and assessment process and then additional screening and assessment services may be purchased if needed, before the completion of the self-sufficiency plan. For more information contact Dennis Ellis, Nebraska Employment First, 402/471-6792. Or, see the Welfare Peer Technical Assistance Summary of the Employment First Program Review at www.calib.com/peerta/pdf/state%20of%20nebraska.pdf.
 
New Jersey. The Mental Health Association in New Jersey (MHANJ) sponsors two programs, Consumer Connections and the Career Connections Employment Resource Institute, designed to help individuals with mental illness, including depression, find and keep employment as part of the recovery process. The New Jersey Division of Mental Health funds both of these programs. Consumer Connections is a comprehensive program designed to recruit, train, and support consumers of mental health services in the role of becoming providers of human services. The program has three components – an employment opportunity bank, an information and referral system for volunteer and employment opportunities; consumer provider training, an intensive fifty-hour training program; and the consumer support network (C.S.N.), a system of support for consumers to maximize their ability to succeed in the workplace. Since its inception, the program has trained over 600 people and approximately 70 percent of those individuals are working, either part-time or full-time, within the New Jersey mental health and human services system. The purpose of the Career Connections Employment Resource Institute is to expand employment opportunities for persons with mental illness. Consumers with mental illness who are interested in entering or re-entering the job market are assigned vocational counselors who provide direct individualized employment services including job matching, ongoing support services, mentoring, entrepreneurial business development, supported education and benefits planning. MHANJ is currently making efforts to include more of the TANF population in this program. For more information, contact Jennifer Miller, MHANJ, 973/571-4100.
 
Pennsylvania. Pennsylvania’s Maximizing Participation Program (MPP), funded by the Pennsylvania Department of Public Welfare, was implemented in July 2001 to offer intensive case management-centered programming to assist clients with diagnosed or undiagnosed barriers to participation and self-sufficiency. After five years of TANF participation, clients who are exempt or have good cause for not working are required to participate in MPP. The program uses a multi-disciplinary approach.  Each client is assigned a case coordinator and a team of behavioral health professionals is assembled to perform a series of comprehensive assessments. With the client's consent, the team may include professionals from local mental health and drug and alcohol agencies, the Office of Vocational Rehabilitation, and other entities. If depression is disclosed or detected, the client is assisted in obtaining an in-depth psychological assessment. The results of this assessment are used, along with input from the client, recommendations of the team members, and other relevant information, to develop an individualized service plan. The team then assists the client in locating and obtaining the recommended treatment and/or service. For more information, contact the Pennsylvania Department of Public Welfare, Office of Income Maintenance, 717/787-1894.
 
WIN Staff Contact: Rachel Sherman, 202-587-1020 or rsherman@financeprojectinfo.org.
 
 
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 William and Flora Hewlett Foundation, and the Ford Foundation.