The American Psychological Association (APA) maintains that in order for welfare reform efforts to be successful, critically needed mental health and substance abuse services must be readily available and accessible to help women to overcome barriers to work and achieve economic self-sufficiency.

Since enactment of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), there have been dramatic decreases in the numbers of families who receive Temporary Assistance to Needy Families (TANF) block grant funds. However, women who face multiple barriers to obtaining and maintaining employment have been the least likely to achieve economic self-sufficiency. According to the 2000 University of Michigan’s Women’s Employment Study, barriers to employment for these women include mental health and/or substance abuse problems, the lack of a high school diploma, transportation difficulties, health concerns (theirs and/or their children’s), and domestic violence. Following are some of APA’s most significant recommendations for provisions to be included in TANF reauthorization legislation:

Rationale: Mental health and substance abuse problems represent significant obstacles to employment and economic self-sufficiency for women receiving TANF benefits. TANF clients with mental health problems, if not identified and treated, are more likely to continue to require public assistance over a long period of time. A 1998 Department of Health and Human Services (DHHS) study reports national estimates of up to 28% of TANF clients with mental health problems, and state and local estimates of up to 39%. Major depression is the most common mental health problem among TANF clients, followed by posttraumatic stress disorder (PTSD) and generalized anxiety. Mental health and substance abuse problems can affect employment directly through abstenteesim, illness, injury, reduced capacity, and lost productivity, or indirectly through lowered self esteem and self concept. TANF recipients may be especially reluctant to disclose mental health and substance abuse problems for fear they will lose their children, their TANF benefits, or both.

Recommendation: States should develop a plan to ensure that standards and procedures are in place to address the needs of individuals who face barriers to work such as, but not limited to, a mental health problem (including learning disabilities), substance abuse problem, physical impairment, and/or have been subjected to domestic or sexual violence. The state plan must ensure that:

• Trained caseworkers or qualified professionals conduct a preliminary screening and assessment of each TANF client. If the client is identified as experiencing a barrier to work, the caseworker or professional must refer, at the client’s option, the client and her family for appropriate mental health or substance abuse treatment, counseling, vocational rehabilitation, and/or job training. Such services must be individualized and appropriate for families, gender-specific, and culturally competent. Support services, such as child care and transportation, must also be offered to help ensure accessibility to the other services.
  

• For those clients for whom treatment or services are unavailable, the five-year benefits clock must stop until the treatment or services are available.
  

• The caseworker or qualified professional assigned to the client’s case must collaborate with employment case managers, with the client’s consent, to ensure that the client receives integrated, comprehensive services.

Rationale: This ban undermines the efforts of mothers to overcome addiction, develop essential marketable skills, become more productive members of their communities, attain economic self-sufficiency, and provide a safe and healthy environment for their children. As women return to their communities, it is counterproductive to endanger their access to food, housing, and clothing for themselves and their children while they are trying to enter or complete substance abuse treatment programs or maintain recovery for addiction.

Recommendation: The ban should be repealed so that women with substance abuse problems can be referred for treatment and obtain vital TANF and food stamps.

Rationale: The FVO allows states to screen recipients for domestic violence victimization, provide referrals to specialized services, and provide good cause waivers from the five-year lifetime limit on TANF assistance and mandatory work requirements. Only 36 states and the District of Columbia have adopted all or part of the option, and two states have authorized at the county level. Women who have experienced intimate violence, either as children or in their adult lives, frequently suffer from low self esteem, PTSD, substance abuse, and homelessness. They are more likely to be unemployed and exhibit high rates of job turnover. Failure to identify and address issues of violence leaves victims at greater risk both for more violence and for long-term poverty. Because disclosing violence in their lives is risky for low-income women, accurate assessment of the prevalence of violence is difficult to obtain. A report for DHHS provides estimates that up to 65% of TANF clients have experienced intimate violence in their lives.

Recommendation: DHHS should create incentives for states to adopt the FVO. In addition, states should provide exemptions to, and extensions of, time limits to all women identified as victims of past, recent, and/or current abuse.

Rationale: Although there have been studies of how individual states have addressed the needs of TANF clients with substance abuse and/or mental health problems, states do not routinely report this information. Therefore, it is difficult to determine whether or not TANF clients are receiving the necessary services to overcome barriers to economic self-sufficiency.

Recommendation: The reauthorization of TANF should include state and federal mandatory data collection, evaluation, and reporting provisions for referrals and services, especially those regarding mental health and substance abuse. The DHHS Secretary should:

• review programs receiving funding from the TANF block grant or funded with maintenance of efforts funds to determine the amount of funds spent on services, including, but not limited to, mental health services, substance abuse treatment, domestic violence counseling, and rehabilitation for people with physical disabilities; and
  

• Evaluate the process of referral, such as, but not limited to, whether recipients received referrals and services, and how such services affected their economic status.

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