Families with a Disabled or Chronically Ill Household Member
By Jan Kaplan
Welfare agencies increasingly are focusing attention
and resources on long-staying clients with multiple barriers to employment
and long-term self-sufficiency. These clients are at increased risk of being
sanctioned because of noncompliance with work participation requirements,
and many are beginning to reach time limits on assistance. A significant
number of long-staying clients have the primary caretaking responsibility
for a household member with a chronic mental or physical health condition or
disability; many have health conditions or physical disabilities themselves.
These caretaking clients face unique challenges that often result in
unstable or unsuccessful employment experiences.
Between 8 percent and 36 percent of children in
families receiving welfare benefits suffer from a physical, developmental,
or behavioral/emotional disorder (Rosman et al., October 2001; and Rosman et
al., 2002). In 8 percent of families receiving TANF, both the adult and
child have a disability (U.S. General Accounting Office, July 2002). Common
physical disorders such as asthma, diabetes, and sickle cell disease can
require medications, laboratory services, ongoing medical care, durable
medical equipment, and home health care. Developmental conditions, such as
autism, speech defects, hearing impairments, orthopedic impairments, and
severe learning disabilities, can require home care, assistive devices, care
coordination, and medical, occupational, physical, speech, and language
therapies. Behavioral or emotional disturbances can require medications,
psychiatric services, family psychotherapy, crisis intervention, and care
Little is known about the proportion of welfare
clients with a disabled or chronically ill adult household member. In 1990,
between 10 percent and 22 percent of women receiving cash assistance through
the Aid to Families with Dependent Children (AFDC) cared for a disabled
adult member of their household. Similar data for the Temporary Assistance
for Needy Families (TANF) program population is not available. Disabilities
affecting adults typically include mental illness, sensory impairments, and
limitations on their ability to perform physical activities (Adler, 1993).
Welfare clients who must care for a disabled or
chronically ill household member can be overwhelmed by their daily tasks,
particularly when they also are responsible for other family members.
Furthermore, a lack of transportation, special-needs child care, and other
supports might prevent them from maintaining employment and fulfilling TANF
program participation requirements.
This Issue Note
provides a general overview of the challenges this population faces and
suggests some policy approaches to help these welfare clients balance their
caretaking responsibilities with progress toward employment and
self-sufficiency. Future publications will address the unique service needs
of TANF families that include individuals with developmental disabilities.
How can TANFagencies identify clients who have caretaking
responsibilities? Clear policies and procedures on screening and assessment facilitate
early and accurate identification of household caretaking issues. Agencies
will need to determine which clients to screen and when to conduct those
initial screens. The most effective approach encompasses initial and
followup screens. Screening all applicants during the intake process enables
more timely access to services and the development of individual
responsibility agreements that reflect the household’s unique needs.
Screens conducted at other times during TANF receipt, such as when a client
is having difficulty complying with program requirements, can help identify
new or previously unidentified caretaking situations in the TANF household.
TANF agencies can use several screening tools to
identify employment barriers, including caretaking responsibilities. Staff
should choose screening instruments that are brief, nonthreatening, and
culturally appropriate. Those instruments can help overcome clients’
reluctance to self-disclose a disabled person in the household because of
fears of involvement with the child welfare or juvenile justice systems or
because of cultural differences in the perception of family responsibilities
and the role of public agencies.
TANF staff or onsite professionals can conduct the
screens. Some agencies might prefer to refer clients to offsite partner
agencies. However, referrals to offsite partner agencies could increase some
clients’ reluctance to participate in the screening process and to be
truthful in disclosing information about their household. Other clients
might feel more comfortable with professionals who are not associated with
the welfare office.
Once a screen identifies a disability or chronic
illness in the household, staff or other professionals should assess the
severity of the problem and the caretaking burden on the TANF client.
Comprehensive family assessments can guide the development of individual
responsibility plans for the receipt of TANF assistance to achieve a balance
between program participation requirements and caretaking needs and issues.
Assessments should gather information on the service and treatment needs of
the disabled household member, the caretaking responsibilities of the
family, and the family’s ability to fulfill those responsibilities.
Often a disabled child or adult will already have
received an assessment through another public agency, the school system, or
a health care provider. TANF agencies need to work with the client and other
agencies to ensure all relevant records and assessments are shared. Expert
clinicians in Medicaid, Children with Special Health Care Needs (Title V),
vocational rehabilitation, special education, developmental disabilities,
and state and community mental health agencies should conduct the onsite or
offsite assessments and lend their expertise to the welfare agency.
services and resources do TANF caretakers of children need? TANF
caretakers need information on and access to service and treatment providers
to address medical, physical, mental health, developmental, behavioral, and
other problems. They might also need transportation assistance to services
and treatment and to employment-related programs; special-needs child care
and child care for other siblings; and special clothing, assistive devices,
nutritional supplements, and home medical equipment.In addition, respite care is critical to the emotional and
physical health of both the caretaker and household members.
Multiple federal, state, and local programs provide
services to families with disabilities. TANF agencies can ensure clients
have complete and early access to these programs by reviewing program
eligibility criteria, thoroughly training TANF caseworkers, and
disseminating outreach and education materials.
For example, the federal Individuals with Disabilities Education Act (IDEA) authorizes early
intervention services for young children up to age three. These services
include family training and counseling and physical, speech, and
occupational therapy in a center or at home. Children above age three
receive special education services through the school system.
Security Income (SSI) provides monthly cash benefits to children with severe
disabilities who meet an income eligibility standard and the SSI definition
of disability. SSI-eligible children are referred to the state maternal and
child health agency for rehabilitation services that are not covered by
Medicaid (see below). Some states are using their own funds to provide cash
assistance to children who lost SSI benefits because of strict federal
States use federal Maternal and Child Health Services Block Grant (Title V) funds to
improve the access of children with special health care needs to routine
health care services and to integrate medical and other community services.
Title V funds also support screening and followup diagnostic, treatment, and
rehabilitation services; initiatives to improve private and public insurance
coverage of special needs care; and initiatives to improve transition
services for youth with special needs.
and the State Children’s Health
Insurance Program (SCHIP) can cover diagnostic, treatment, and
rehabilitative services for children with special health care needs and
offset large out-of-pocket expenses among TANF caretaking families. Although
downturns in state economies make new initiatives to expand coverage
unlikely, ongoing outreach efforts can be broadened to include information
on available benefits and coverage for children with special health care
needs, particularly those ineligible for SSI. States also might consider the
feasibility of providing in-home services to these children through Medicaid
home- and community-based services waivers.
Community Mental Health System Services for Children and Their Families
grants support community-based systems of care for children with serious
emotional problems. Although large matching requirements have deterred some
states from applying for these grants, other states are using the funds to
expand community-based mental health services for uninsured or underinsured
children.In addition to
services funded through these grants, state child welfare and juvenile
justice systems provide support and intervention services to children and
youth with behavioral or emotional problems and their families.
can assist TANF caregivers of adult household members?
Like caretakers of children with special health care needs, TANF clients
with adult household members who have a chronic illness or disability need
help to meet daily care needs. These clients also frequently need access to
medicines, nutritional supplements, special clothing, transportation
assistance, durable medical equipment, home-based medical care, and
alternative care arrangements such as adult day care. Respite care also is
critical to the well-being of the entire family.
TANF caregivers of older adults may receive services
through state Family Caregiver Support Programs (FCSP) administered by state
units on aging and funded through the federal Older Americans Act. FCSPs
provide information and referrals to care-related services, offer counseling
and support groups, arrange respite care, and supplement the care services
provided by the caregiver. State units and area agencies on aging also
provide advocacy and ombudsman assistance as well as home- and
community-based support services. For more information, see the
Administration on Aging, 2002. In addition, older disabled or chronically
ill adults in TANF households are likely to have some treatment and daily
care needs covered through the Medicaid, Medicare, Social Security, and Food
Other adults with disabilities or chronic illnesses
in TANF households have many of the same daily care and ancillary service
needs. In addition, they might need substance abuse or mental health
services, employment training, or vocational rehabilitation. Some
individuals might be able to access these supports through SSI, the Food
Stamp program, state vocational rehabilitation programs, or other state
workforce preparation programs. Severely disabled adults may be eligible for
in-home medical and rehabilitation services under the Medicaid home- and
community-based services waiver program. Visit http://www.ssa.gov
How can TANF
agencies help caretaking clients meet work participation requirements? Prior
to the enactment of the Personal
Responsibility and Work OpportunityReconciliation
Act (PRWORA), welfare clients with caretaking responsibilities for a
household member with a disability or chronic illness were exempt from
participating in work-related activities. PRWORA, with its strong
welfare-to-work orientation, eliminated those “blanket” exemptions.
Furthermore, the welfare reform law limits the activities that can be
counted toward a state’s work participation rate. However, states have
some flexibility to design policies that can help caretaking clients meet
their household needs and comply with program responsibilities. That
flexibility also enables states to design policies that fulfill their
federal statutory and regulatory obligations to afford families with
disabilities equal access to welfare-related services (see Sweeney, February
Most states have met their federal work participation
requirements and received a caseload reduction credit that reduces their
work participation rate in proportion to the reduction in their TANF
caseload. Those states may define their own allowable work activities. They
could consider ways to allow caretakers to remain in the home and have a
flexible schedule that enables them to meet the medical and service needs of
their family member. Examples include telemarketing or part-time in-home
child care. In addition, states could allow activities directly related to
the care of the family member, such as daily care for a severely disabled
family member, participation in support groups or training sessions on care
and treatment, and attendance in health, mental health, counseling, and
other service sessions. Volunteering in school, child care, or service
delivery settings involved in the care and treatment of the family member
could also be allowed.
In addition, state maintenance-of-effort (MOE) funds
may be used to support caretaking clients who meet state-established work
requirements. States that do not combine MOE and federal TANF funds are not
subject to federal program requirements.
States also may exclude up to 20 percent of their
clients from work requirements. Although states with broadly defined
allowable work activities might not want to exempt caretakers from
participation requirements, others might choose to exempt specific
categories of caretakers, such as those caring for a spouse or child.
Exemptions also could be based on the availability of alternative care
arrangements, the severity of the disability or illness, or the presence of
additional employment barriers, such as depression or a lack of job skills.
states modify their time-limit policies to meet the needs of TANF clients
withcaretaking responsibilities? States can use the flexibility afforded
to them under PRWORA to protect certain caretaking clients from losing
assistance because of time limits and to continue to help clients who have
reached their time limits become work-ready. According to the State Policy
Documentation Project (June 2000), 22 states have chosen to exempt clients
who are caring for a disabled household member from time limits. In those
states, months in which those individuals receive assistance are not counted
toward the time limit. Eighteen states extend assistance for a caretaking
client beyond the time limit. States opting to provide exemptions and
extensions to caretaking clients can implement their policies in several
ways. First, many states have not set specific eligibility criteria for a
time limit exclusion, relying on federal language. However, states might
want to develop specific criteria that address caretaking responsibilities
to increase the likelihood that those clients are properly assessed and
their needs are identified. Criteria could be based on the severity of the
disability or illness, the age of the disabled or ill family member, needed
treatment or services, or the availability of other care providers, child
care, adult day care, or respite services. Alternatively, states could
establish more general criteria to give caseworkers discretion to identify
and meet unique client needs that might not be addressed in set criteria.
Second, uniform procedures for evaluations and assessments, adequate staff
training, and supervision can help ensure clients are treated equally and
exclusions are offered when appropriate.
Third, it is important that clients who receive time
limit exemptions or extensions because of their caretaking responsibilities
continue to receive services and supports that can help move them closer to
self-sufficiency. TANF caseworkers and staff in other agencies can develop
coordinated plans for training or services to help clients balance their
caretaking responsibilities and employment preparations.
Finally, states can address the ongoing needs of
caretaking clients who lose their cash assistance because of time limits.
States can provide support services and assistance to prevent financial
hardship and additional caretaking burdens through service maintenance plan
development, ongoing case management, periodic family assessments, and
referrals to community service providers. States with shorter time limits
could continue TANF benefits for disabled children in the caretaker
household. Those extended benefits would not count toward the 20-percent
federal threshold for extensions. Some state safety net programs for
families that reach their time limits provide referral and care coordination
services or cover the costs of medical treatment and other expenses
associated with the care of a disabled or chronically ill family member. For
more information, see Kaplan 2001; or Rosman et al., October 2001.
What changes to
sanctions policies could states consider to address the needs of TANF
clients with caretaking responsibilities? Some states have reoriented their sanctioning
policies and practices to address the needs of their hard-to-serve clients.
States, particularly those with less flexible work requirements, might want
to evaluate their sanctions policies to ensure they reflect the needs of
caretaking clients and do not cause undue hardship.
First, sanctions can be avoided with a reasonable
personal responsibility plan that balances TANF participation expectations,
caretaking issues, and obligations families might have under other programs,
such as IDEA and child welfare. Particularly effective plan components for
these clients include intensive case management, referrals to needed
services, periodic reassessments, and ongoing followup to identify emerging
Second, states could adopt “good cause”
provisions that allow clients with overwhelming caretaking burdens to be
excluded from program participation requirements and thus to avoid
sanctions. To date, 37 states provide good cause exemptions for this
population (State Policy Documentation Project, June 2001). Exemptions for
good cause could be granted during the initial screening and assessment
process, when the client is determined to be at imminent risk of sanction,
or at any other time during TANF receipt. States with good cause provisions
might want to review their caseworker training and notification procedures
to ensure caretaking clients have access to any exemptions.
Third, pre-sanction reviews and conciliation
procedures in which caseworkers identify and address the causes of
noncompliance can be particularly effective with clients with caretaking
responsibilities. Pre-sanction reviews of the appropriateness of a sanction
decision results in caseworker intervention prior to the imposition of the
sanction. The conciliation process enables the client and caseworker to work
together to address the underlying issues that led to noncompliance. As a
result of these interventions, the client may receive a good cause exemption
or a new intervention plan to help her achieve compliance and avoid the
Fourth, some states use full-family sanctions to
communicate their strong commitment to personal responsibility and program
compliance. However, this penalty can place undue hardship on a household
with a disabled family member by reducing their ability to purchase and
otherwise access needed services. States with full-family sanctions might
want to clarify or strengthen any good cause exemptions or conciliation
procedures. In addition, special attention should be given to approaches
enabling the continuation of care for disabled household members.
States also can take steps to ensure other public
benefits remain available for sanctioned caretaker clients. Although a
child’s Medicaid coverage cannot be terminated when a family is
sanctioned, states may eliminate this coverage for adults. Given the
importance of Medicaid in the delivery of critical treatment and
rehabilitation services for adults with disabilities, states should consider
continuing this coverage. In addition, maintaining food stamp benefits would
provide ongoing access to needed nutrition for the disabled family member.
Finally, states can adopt several administrative
changes to ensure the fairness and effectiveness of their sanctions
policies. States might want to establish reliable tracking and notification
systems and develop procedures to inform and educate clients about sanction
policies and the implications of their noncompliance with program
requirements. They also might want to adopt due process procedures to allow
clients to dispute a sanction and to train staff so practices are uniform
within and across agencies. For more information, see Kaplan, April 1999.
How can access
to special-needs child care be improved for TANF clients? A
lack ofchild care continues to
be a major barrier to employment for many low-income women, particularly
TANF clients who have a child with special health care needs. A lack of
specialized child care can be the primary reason these clients do not meet
TANF program requirements.
A few strategies can increase the supply of child
care for children with special needs and clients’ access to such care.
First, PRWORA allows states to use TANF funds for direct spending on child
care or to transfer up to 30 percent of their current-year funds to the
Child Care Development Fund (CCDF). Although budget constraints at the state
and local levels will likely prevent the allocation of new resources,
available TANF funds can be used to expand subsidies for the entire TANF
caseload or for clients who have children with special needs.
Pooling TANF and funds from other agencies and
programs that serve children with special needs can be particularly
effective to increase the supply and quality of special-needs child care.
Sources of funding include CCDF, Medicaid, SCHIP, IDEA, Head Start, the
Social Services Block Grant, and the Maternal and Child Health Block Grant.
These funds can be used to set higher reimbursement rates for providers who
care for children with special needs and for training and counseling for
providers. They also can be used for technical assistance on facility
modifications and other issues related to the provision of special-needs
care or to facilitate interagency collaborations on other expansion
States also need to ensure caretaking clients are not
wrongfully sanctioned when special-needs child care is unavailable. Under
federal law, single custodial parents of a child below age six cannot be
sanctioned if they are prevented from meeting program requirements because
of a lack of “appropriate” or “suitable” child care, as defined by
the state. Although at least 14 states have specifically extended this
protection to children above age five who have special needs, many states do
not stipulate what constitutes appropriate care for this population (see
State Policy Documentation Project, July 2000). Clear state guidance that
defines “appropriate” or “suitable” care for children with special
needs can lead to more consistent caseworker practices, protect the parent
from wrongful sanctioning, and prevent placement in a child care setting
that is not equipped to provide specialized care.
Finally, resources should be dedicated to outreach
and education on the availability of subsidies, the supply of providers
trained to care for children with special needs, and the protections
afforded under federal law, including the Americans with Disabilities Act
(ADA). Caretakers should be made aware of ADA’s requirement that private
child care providers accept children with disabilities, offer appropriate
aids and services to those children, and make needed physical modifications
to their facilities to ensure accessibility (see U.S. Department of Justice,
How can TANF
agencies and other service providers work together to meet the needs of
clients with caretaking responsibilities? State- and local-level coordination of the multiple
agencies that serve caretaking clients can reduce duplication, prevent turf
conflicts, and enhance the effectiveness of interventions that might lead to
future employment and self-sufficiency.Clear articulation of policy goals is critical to coordination efforts
at the service delivery level. In addition, interagency coordination
strategies can help these families meet their daily challenges.
First, cross-training TANF and disability-related
service providers can facilitate a mutual understanding of roles and
responsibilities, foster cooperation on intervention strategies, and address
gaps in service expertise. TANF staff could be trained on service delivery
approaches, care planning strategies, and the major types of disabilities
and illnesses affecting different age groups. Providers could receive
training on TANF rules and requirements, the availability of TANF-supported
ancillary services, the purpose of personal responsibility agreements, and
case management methods.
Second, collocation in the TANF office of staff from
agencies that treat people with disabilities and chronic illnesses can
increase the effectiveness of screening protocols and serve as an important
technical assistance resource. Collocation also enables TANF clients to
receive assessment, referral, and case management services in one site and
helps prevent duplicative or conflicting services.
Third, case staffing and the development of
coordinated family service plans provide a comprehensive framework for the
delivery of services. Together, staff can develop plans that outline policy
and program goals, address competing program expectations, and define roles
and responsibilities for case monitoring and followup. Modifying
inconsistent program rules and requirements can facilitate the effective
development and implementation of a comprehensive service plan.
Cross-agency tracking and information systems are
critical to the ability of case staffing teams to monitor clients’ receipt
of services and progress toward meeting service goals. Some states and
localities have initiatives to develop and improve integrated management
information systems that will enable them to serve clients across agencies.
Integrated systems can be expanded to include agencies that provide services
to TANF caretakers and their families, fully integrate intake and tracking
systems, and expand information and referral databases.
Finally, states can use existing funds to support the
coordination of care and services for this population. Funds could be pooled
across agency lines. In addition, states could use TANF funds for
assessments and counseling, state MOE funds for various treatment and
support services, and pooled TANF and child care-related funds to increase
access to special-needs child care. States also couldcombine, transfer, or reallocate Medicaid, Social Services Block
Grant, and other federal funds to support the coordinated delivery of
services. However, given differences in participation and reporting
requirements for many of these federal programs, states will need to be
careful in their accounting procedures to ensure compliance with program
Researchers have found that families with children
with special health care needs are more likely to be impoverished and to be
welfare-dependent. A study by Meyers et al. (October 2000) on the public and
private cost of caring for disabled children in California found that 45
percent of families incurred an average of $134 in excess direct costs for
specialized care and equipment each month. At the same time, those families
lost $80 in earnings. The families were 30 percent more likely to suffer
financial hardship than families without a disabled child and were more
likely to have trouble paying bills, suffer from hunger, and have periods of
homelessness. They also were more likely to need costly public benefits.
Between 43 percent and 75 percent of the families were served by special
education or early intervention programs, and they were more likely to live
in public housing and participate in the TANF, Medicaid and Food Stamp
Similarly, an analysis of U.S. Census data found
adults with disabilities are more likely to be poor. More than half of
severely disabled individuals above age 65 lived in households with annual
incomes below $20,000, compared with 34.1 percent of older adults without a
disability. Nearly 17 percent of households with a disabled older adult
lived in poverty, compared with less than 7.0 percent of households without
a disabled older adult. In addition, 41.8 percent of severely disabled
adults between the ages of 25 and 64 lived in households with annual incomes
below $20,000, compared with 13.9 percent of adults ages 25 to 64 without a
disability. Almost 28.0 percent of those with a severe disability lived in
poverty, compared with 8.3 percent of those without a disability (McNeil,
Other researchers have looked at the effect of
caretaking responsibilities on welfare exits and successful employment. The
U.S. General Accounting Office (December 2002) concludes TANF clients who
care for children with a disability or health problem are less than half as
likely to leave welfare as clients without similar caretaking
responsibilities. Danziger and Seefeldt (2002) found that 6.6 percent of the
women in their study who had not found ongoing employment had a child with a
chronic condition, compared with 3.1 percent of women who were successfully
employed. They also found that 8.6 percent of the women who remained on TANF
had a child with a health problem, compared with 3.0 percent of those with a
shorter duration of TANF receipt. In a similar study, Tout et al. (March
2002) found that 20 percent of the children of long-staying welfare clients
had a limiting condition, compared with 14 percent of the children of
Brandon and Hogan (September 2001) conclude the
considerable financial and time constraints imposed on families receiving
welfare that have caretaking responsibilities are the cause for negative
employment and welfare outcomes. Another study by LeRoy et al. (November
2000) identifies child care as the most significant barrier to
self-sufficiency for families that receive welfare and have a child with a
A survey of state policy decisions found that 42 of
48 states with state-administered programs have the same work participation
requirements for clients who are caregivers as for individuals with a
disability. Eleven states require a determination of the need for full-time
care for the disabled household member and an analysis of the
appropriateness of alternative care before allowing exclusions from work
requirements. Two states require all caregivers to participate in
work-related activities. In these states, TANF staff spend additional time
exploring alternative care arrangements and may permit in-home activities to
count toward work requirements (Thompson, October 1998).
The following programs illustrate the policies and
programs that states and localities are implementing to address the needs of
caretaking TANF clients. For more examples, see the Welfare Information
Network (April 2002).
Atlanta, Georgia. Child CareSolutions is a child care resource
and referral service that educates consumers and providers about issues
related to the growing need for special-needs child care. The program works
to increase the number of caregivers who offer nontraditional care and
maintains data on child care facilities and family child care homes that can
offer specialized care for children with disabilities, particularly for
welfare clients. Contact Pam Runkel, 404/479-4233.
Kentucky. Kentucky conducts assessments of all clients upon
initial contact with the welfare agency. The case manager, with assistance
from other agencies as needed, reviews the family’s situation to identify
barriers, including caretaking responsibilities. The state gives work
participation exemptions to individuals who provide care for a parent,
spouse, or child with a disability for at least six hours daily and who do
not have access to alternative care arrangements. Kentucky’s sanctions
policy also allows good cause exemptions for these clients. Contact Dianne
Maryland. Maryland’s separate MOE-funded State Temporary
Cash Assistance Program serves families with a physically or mentally
disabled adult or child living in the household. These families are exempted
from time limits and work requirements but are required to apply for SSI and
Social Security Disability Insurance (SSDI). Once the disabled household
member receives SSI or SSDI, they are removed from the assistance unit and
the family is required to reimburse the state for cash benefits paid to
them. If there is another eligible child in the home, the family is moved
back into the federally funded TANF program. Contact Charles Henry,
New Jersey. New Jersey’s time-limit policy exempts caregivers
from the 60-month lifetime limit on benefits. In contrast, the state only
gives time-limit exemptions to clients with disabilities who have been
exempted from work requirements. The state also extends eligibility for cash
assistance to families with a child up to the age of 21 if that child is
enrolled in a special education program. If the child is the only child in
the family, New Jersey uses state-only funds to provide that assistance.
Contact Work First New Jersey,800/792-9773.
Tennessee. Tennessee’s Family Services Counseling Program
serves clients who have been identified during the TANF application or
recertification process as having employment barriers, including a child
with health or behavioral problems. Clients are referred to masters
degree-level therapists for advocacy, service planning, home visits,
intensive case management, short-term counseling, and ongoing followup.
During the assessment process, the time limit clock is stopped. Contact the
Tennessee Department of Human Services, 615/313-5652.
Washington. Washington’s No Wrong Door Case Coordination
Project provides long-term case coordination to long-staying TANF families,
including those with a household member with a disability, that are
receiving services from multiple agencies. A multidisciplinary team,
composed of staff from the state’s Department of Social Services and local
organizations, works with the client to develop a client-centered,
integrated service plan. Key elements of the project include cross-training
of agency staff; a service broker/coordinator or lead case manager who
coordinates planning and service delivery; information technology
applications to facilitate interagency communication; monitoring and
evaluation of the service plan and outcomes; flexible funding; and
collocation of multidisciplinary team members. Contact Ed Hidano,
Bazelon Center for Mental Health Law, Chris Koyanagi,202/467-5730.
Danziger, Sandra K., and Kristin S. Seefeldt. Barriers
to Employment and the “Hard to Serve”: Implications for Services,
Sanctions, and Time Limits. Madison, Wis.: University of Wisconsin,
2002. Available at http://www.ssc.wisc.edu/irp/focus/foc22/-part3.pdf.
Meyers, Marcia, et al. Expensive Children in Poor Families: The Intersection of Childhood
Disabilities and Welfare. San Francisco, Calif.: Public Policy Institute
of California, October 2000. Available at http://www.ppic.org/publications/PPIC140/index.html.
Rosman, Elisa, et al. Adults with Mental Health Needs and Children with Special Needs: A
Series of Issue Briefs. Washington, D.C.: Georgetown University Center
for Child and Human Development, October 2001. Available at http://www.georgetown.edu/research/gucdc/wfbriefs.html.
Rosman, Elisa, et al. Towards an Understanding of the Impact of Welfare Reform on Children
with Disabilities and Their Families: Setting a Research and Policy Agenda.
New York, N.Y.:
Sweeney, Eileen P. HHS Guidance Explains How Federal Laws Barring Discrimination Against
People with Disabilities Apply in State and County TANF Programs.
Washington, D.C.: Center on Budget and Policy Priorities, February 2001.
Available at http://www.cbpp.org/2-26-01wel.htm.
State Policy Documentation Project. Sanctions
for Noncompliance with Work Activities. Washington, D.C.: State Policy
Documentation Project, June 2001. Visit http://www.spdp.org/tanf/sanctions.htm.
U.S. General Accounting Office. Welfare Reform: Former TANF Recipients with Impairments Less Likely to
be Employed and More Likely to Receive Federal Supports. Washington,
D.C., December 2002. Available at http://www.gao.gov.
U.S. General Accounting Office. Welfare Reform:Outcomes for
TANF Recipients with Impairments. Washington, D.C., July 2002. Available
Welfare Information Network is supported by grants form the Annie E. Casey
Foundation, the Charles Stewart Mott Foundation, the David and Lucile Packard
Foundation, the William and Flora Hewlett Foundation, the Ford Foundation, and
the Administration for Children and Families, U.S. Department of Health and