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Executive Summary
Since the passage of federal welfare reform legislation in 1996, welfare caseloads have declined dramatically assisted, in part, by a strong economy. However, many families have not made the transition to employment. Many recipients of Temporary Aid to Needy Families (TANF) experience a variety of barriers that make it difficult for them to work. These barriers include poor work skills, low educational attainment, difficulty securing childcare and transportation, and health and mental health issues. As states face rising federal work participation rates and approaching time limits, there is an increasing need to find effective strategies to assist those who experience barriers to employment.
Substance abuse has been identified as an important problem to address among hard-to-employ TANF recipients. Although accurate prevalence rates of substance abuse problems among TANF recipients are hard to obtain, some studies indicate that 10-20% have a substance abuse problem. Many welfare systems have implemented special programs to screen for substance abuse and refer recipients to treatment. However, very little is known about TANF recipients who have a substance abuse problem. As a result, minimal information is available to guide policy makers and program administrators about the types of services this population needs to transition to employment.
The purpose of this study was to learn more about the substance abuse problems and other barriers to employment of women on TANF who were identified as being dependent on alcohol or other drugs. The study examined the nature, severity, course, and treatment needs for substance abuse problems in this population. The study also assessed problems in seven other areas thought to be barriers to employment. Because most women on TANF experience some barriers to employment, the study compared women with a substance abuse problem to those without a problem. This comparison allowed us to study and determine whether substance-abusing women were more impaired than other women on welfare across important domains related to employment. Finally, the study examined the well-being of children based on mother's self-report.
The typical substance abuse sample member was in her mid-thirties, African-American, not married, was the mother of 3-4 children, had not completed high school, earned less than 50% of the poverty threshold, and had received welfare benefits for 12 years. The typical non-affected (without a substance abuse problem) sample member was in her late twenties, African-American, not married, was the mother of 2-3 children, had completed high school, earned above 50% of the poverty threshold, and had received welfare benefits for 6 years. The non-affected sample was significantly younger, had fewer children, and had spent less time on welfare.
Women in the substance abuse sample reported serious and chronic substance abuse problems. Most were addicted to heroin or cocaine. On average women drank heavily or used drugs on about 2 of every 3 days in the prior month and had extensive histories of prior substance abuse. Women required intensive treatment placements to address their problems, including one-third who required inpatient treatment. Despite the severity of substance abuse problems, half of women had not received prior substance abuse counseling.
Women in the substance abuse sample reported low education, low job skills, and limited work experience. More than half (56%) did not complete high school, 52% reported no job skills, and only 19% worked regularly in the past three years. Women in the non-affected sample had significantly greater levels of education, job skills, and work experience. More than half (57%) completed high school, 71% reported job skills, and 44% worked regularly in the past three years.
Women in the substance abuse sample reported high levels of other problems, particularly in the areas of mental health, family, legal, basic needs, and stressful events. About half (48%) were diagnosed as suffering from major depression or post-traumatic stress disorder. About one in three reported serious family problems in the recent past: 35% reported high levels of family conflict, 31% reported being the victim of severe physical violence from a partner, and 38% reported currently being under investigation by child protective services. Issues of caring for children appeared to be problem for the overwhelming majority of substance abusers: 84% had ever been investigated by child protective services. The average number of investigations, among those investigated, was seven. Over half (56%) had been arrested and 25% had been incarcerated. Women also reported high levels of problems with basic needs: 51% reported living in unstable housing and 40% reported serious problems with transportation. In addition, 65% experienced a major stressful event (e.g., serious illness of child, being evicted) in the last year. Not surprisingly, women were rated as requiring additional services in multiple areas, beyond simply substance abuse treatment.
Women in the non-affected sample experienced significantly fewer problems in all areas than those in the substance abuse sample. Differences were greatest in the areas of mental health, family, and legal problems. For example, among the non-affected sample 15% required mental health services, 6% required family services, and 3% required legal services. By comparison, need for services among substance abusers were as follows: 46% required mental health, 51% required family, and 21% required legal services. At the same time, women in the non-affected sample also experienced barriers to employment. Barriers occurred primarily in the area of labor market skills (education, low work experience). However, about 10% of women experienced barriers in the areas of physical health, child's physical health, legal, childcare, domestic violence, involvement with child protective services, transportation, and depression. In addition, almost half (42%) of women in the non-affected group experienced a major stressful event in the last year.
The study also examined indicators of child well being based on mothers'
report. Overall, there were few significant differences between samples
for young children, ages 0 to 5. However, among older children (ages 6-17)
substance abusing mothers reported significantly greater physical health,
behavioral health, and academic problems. Differences were greatest for
adolescents (ages 12-17). Substance abusing mothers reported high levels
of physical health problems (20%) and risk behaviors: 17% reported a child
who became pregnant as a teen, 12% reported a child was arrested, and
40% reported a child was expelled or suspended from school.
Overall, study findings indicate that women identified in welfare settings
as dependent on alcohol or other drugs experience high levels of psychosocial
impairment and family dysfunction. These women differ from other women
on TANF and are unlikely to transition into employment through the typical
welfare-to-work employment and training programs. The serious and chronic
substance abuse problems indicate the need for intensive treatments with
strong aftercare components. In addition, the level of problem severity
suggests that relapse will be a common phenomenon even among those who
complete treatment. Findings also indicate the need for additional services
in multiple domains: including mental health, family, basic needs, and
medical services. These findings are consistent with earlier studies suggesting
that substance-abusing mothers have multiple co-occurring problems, but
raise concerns because standard substance abuse treatment does not typically
provide these services. One strategy to improve care is providing intensive
case management to enhance access to care and coordinate services across
disparate providers. Another strategy is to develop programs to provide
integrated care specifically designed for these women.
Findings also raise questions about expected time frames for substance abusing TANF women to become employed. With the restructuring of welfare as a temporary program, states view the time required to transition into employment in terms of months. However, it seems unlikely that women with high levels of behavioral health problems, unstable living situations, and low levels of employment skills will be able to make the transition to employment that quickly. Substance abuse treatment and welfare systems should consider this issue. Substance abuse treatment programs need to figure out how to integrate employment training activities into standard treatment to begin the process of preparing women for work. Welfare policy makers and administrators need to determine what changes to welfare requirements will accommodate the realities of substance abusing and perhaps other hard-to-employ populations.
Findings also indicate alarmingly high levels of family dysfunction. On average, substance abusing mothers were investigated multiple times by child protective services, one-third are currently under investigation, one-third report severe domestic violence, and many report teens engaging in high risk behaviors. To date, most discussions about substance abusing TANF recipients has focused on the need for substance abuse treatment. However, it seems unlikely that women will be able to secure or sustain employment without addressing family issues as well. More thought is needed by welfare policy makers and others in the public health community about effective strategies to strengthen these high-risk families.
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