Vol. 7, No. 1                                                                                                                          January 2003
Serving 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 coordination.
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.
Policy Issues
How can TANF agencies 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.
What ancillary 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.
Supplemental 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 eligibility criteria.
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.
Medicaid 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.
Comprehensive 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.   
What services 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 Stamp programs.
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 or www.disabilityinfo.gov.
How can TANF agencies help caretaking clients meet work participation requirements? Prior to the enactment of the Personal Responsibility and Work Opportunity Reconciliation 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 2001).
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.
How might states modify their time-limit policies to meet the needs of TANF clients with caretaking 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 participation barriers.
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 sanction.
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 of child 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 initiatives.
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, October 1997).
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 could  combine, 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 regulations.
Research Findings
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 programs.
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, 1997).
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 welfare leavers.
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 disability.
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).
Innovative Practices
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 Andrews, 502/564-3440.
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, 410/767-7338.
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, 360/902-7552.
Resource Contacts
  Publications and Electronic Resources
Adler, Michelle. Disability Among Women on AFDC: An Issue Revisited. Washington, D.C.: U.S. Department of Health and Human Services, 1993. Available at
Administration on Aging. Implementing the National Family Caregiver Support Program: Caretaking Resources for the Aging Network. Washington, D.C.: U.S. Department of Health and Human Services, 2002. Visit http://www.aoa.gov/may2001/factsheets/family-caretaking.html.
Administration on Aging. A Profile on Older Americans. Washington, D.C.: U.S. Department of Health and Human Services, 2000. Available at http://research.aarp.org/general/profile_2001.pdf.
Brandon, Peter D., and Dennis Hogan. The Effects of Children with Disabilities on Mothers’ Exit from Welfare. Evanston, Ill.: Joint Center for Policy Research, September 2001. Available at http://www.jcpr.org/wpfiles/brandon_hogan_SR12001.pdf.
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.
Kaplan, Jan. The Use of Sanctions Under TANF. Washington, D.C.: Welfare Information Network, April 1999. Available at http://www.welfareinfo.org/sanctionissuenote.htm.
Kaplan, Jan. What Happens Next?: Post-Time-Limit Programs. Washington, D.C.: Welfare Information Network, December 2001. Available at
LeRoy, Barbara W., et al. Open Road or Blind Alley?: Welfare Reform, Mothers and Children with Disabilities. Detroit, Mich.: Wayne State University, November 2000. Available at
McNeil, Jack. Americans with Disabilities: 1997. Washington, D.C.: U.S. Bureau of the Census, 1997. Available at http://www.census.gov/hhes/www/disable/sipp/disab97/asc97.html.
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.
National Center for Health Statistics. Health, United States, 1994. Atlanta, Ga.: Centers for Disease Control and Prevention, 1994. Available at http://www.cdc.gov/nchs/data/hus/hus_94.pdf.
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.: Society for Research in Child Development, 2002. Available at http://www.srcd.org/spr16-4.pdf.
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.
State Policy Documentation Project. State Time Limits on TANF Cash Assistance. Washington, D.C.: State Policy Documentation Project, June 2000. Visit http://www.spdp.org/tanf/timelimit.htm.
State Policy Documentation Project. The TANF Child Care Protection: Families Covered. Washington, D.C.: State Policy Documentation Project, July 2000. Visit
Thompson, Terri S., et al. State Welfare-to-Work Policies for People with Disabilities: Changes Since Welfare Reform. Washington, D.C.: Urban Institute, October 1998. Available at http://aspe.hhs.gov/daltcp/reports/wel2wks.htm.
Tout, Kathryn, et al. Children of Current and Former Welfare Recipients: Similarly at Risk. Washington, D.C.: Child Trends, March 2002. Available at
U.S. Department of Justice. Commonly Asked Questions About Child Care Centers and the Americans with Disabilities Act. Washington, D.C., October 1997. Available at
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 at http://www.gao.gov.
Welfare Information Network. TANF Recipients as Caregivers for Family Members with Disabilities. Washington, D.C.: Welfare Information Network, April 2002. Available at http://www.welfareinfo.org/TANFrecipientsascaregiversRN.htm
Whitney, Terry, et al. Funding Inclusive Child Care. Denver, Colo.: National Conference of State Legislatures, January 1999. Available at http://www.ncsl.org/programs/cyf/ficcslr.htm
Woolverton, Maria, et al. Exploring Opportunities for Addressing Children’s Mental Health and Child Welfare Issues. Washington, D.C.: Georgetown University Child Development Center, 2000. Available at http://www.georgetown.edu/research/gucdc/wfpubchptr1.pdf.


The 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 Human Services.