The study results have a number of implications for policy makers in designing and implementing more effective services for TANF recipients with the most important barriers to employment and longterm self-sufficiency. Based on the report’s findings, the key barriers to employment are physical and mental health problems, educational deficits, learning disabilities, lack of job skills, and having to care for a sick or disabled family member. Specialized assistance targeted to welfare recipients with these problems would clearly be helpful. Basic employment-related services such as job search, child care, and transportation are unlikely to address the needs of these recipients sufficiently.
- Need for in-depth assessment procedures and responsive programs
Some of the most important barriers to employment – especially mental health problems and learning disabilities – may not be recognized by an intake worker or case manager and, in many cases, not by the recipients themselves. Depression may be misconstrued as “lack of motivation” by caseworkers, as well as by employers. Problems that recipients with learning disabilities experience in finding or keeping a job may be misdiagnosed as more general employability problems, while the underlying barrier is not addressed.
Although they qualify for Medicaid, TANF recipients may not have been properly diagnosed and treated. Access to quality health care and/or transportation may be limited, especially in rural areas. In addition, the possibility that their health impairment(s) may qualify them for SSI may not have been adequately investigated. This study showed that many recipients with physical health problems also have mental health problems. The links between persistent and/or chronic health impairments, chronic pain and depression are well documented3. As discussed, some respondents with health problems have been granted exemptions while others have not.
For recipients with depression, anxiety, and related mental health problems, case managers should be trained in using good assessment instruments, in recognizing symptoms of mental illness, and in coordinating care with the local mental health community for appropriate referrals and treatment. Monitoring clients in treatment, providing support services for the client and family, and making appropriate job referrals when the client is ready are important case management functions. In addition,
when recipients with health problems are able to work, caseworkers should ensure that job responsibilities are reasonable given health limitations. Closer coordination with vocational rehabilitation agencies may also be helpful. Many older TANF recipients were shown to have physical health conditions that impair their ability to work.
The findings indicate that high school dropouts often have learning problems as well as difficulties with math, reading, and overall functional literacy. High school dropouts may be referred to GED programs or basic education programs on the assumption that their major employment barrier is the lack of a high school diploma. However, referring clients with undiagnosed learning problems to the same type of educational program in which they initially (or repeatedly) failed is unlikely to remediate underlying problems. More specialized assessments and programs would help recipients with learning problems and functional deficits find and retain more appropriate employment. Again, closer coordination with vocational rehabilitation programs, such as sheltered workshops, may be fruitful.
- Need to recognize that the most important barriers to employment are especially common among certain sub-groups of welfare recipients
State and local program managers should pay special attention to the possible presence of mental health problems and physical health limitations among older welfare recipients and among divorced or separated recipients. Re-assessment of older recipients in the caseload to ensure proper diagnosis and treatment for health problems should be considered, as should more intensive screenings for new TANF entrants over a certain age. Special attention should be focused on identifying, assessing, and serving TANF recipients with multiple barriers.
- Importance of additional research
Additional research should focus on the dynamics of multiple barriers as they affect employment and self-sufficiency. These barriers include the specific types of physical and mental health impairments faced by TANF recipients, especially by older recipients, and other life circumstances such as histories of abuse and/or neglect and stress from impoverished and/or dangerous living conditions. Additional research should also be conducted on the nature and extent of learning disabilities among high school
dropouts, and on the issue of low functionality in the TANF caseload. In combination, this research would be valuable for developing more specific intervention strategies to help TANF recipients with the most important employment barriers.
3 A thorough literature review and discussion of the relationship between chronic pain, anxiety and depression can be found at Michael Clark, MD, “Chronic Pain, Depression and Antidepressants: Issues and Relationships” John Hopkins University Division of Rheumatology website.