As welfare caseloads decline, states increasingly are faced with the challenge of addressing the needs of hard-to-serve families who experience a variety of barriers to employability. Substance abuse is one of the major problems affecting hard-to-serve families. Since welfare reform was adopted, estimates suggest that 15% to 35% of welfare recipients have a substance abuse problem. Although substance abuse among welfare recipients is thought to be a prevalent and serious problem, it is widely recognized that individuals with substance use disorders often fail to acknowledge that they have a problem or seek treatment. Therefore, developing effective screening, identification, and referral strategies are necessary components of any state plan to address substance abuse among welfare recipients.
The purpose of this report is to describe results of two approaches to screening for substance abuse among TANF recipients in New Jersey (NJ). Results of this report suggest that a generic approach to screening in welfare settings — one that relies primarily on caseworkers administering paper and pencil measures as part of benefit eligibility determination — is useful, but that specialized screening programs can substantially increase case identification rates. This study employed a program evaluation rather than an experimental design. Specifically, the first approach was implemented and outcomes were monitored. Based on an evaluation of these findings, a second approach was designed and implemented in an attempt to boost case identification rates. The first approach was implemented statewide in NJ beginning in 1998. In this approach, welfare caseworkers administered a brief paper and pencil measure to screen for alcohol and other drug use problems to all individuals being interviewed for initial or redetermination of TANF benefits. Those screening positive were then referred to a specially trained addiction counselor for further assessment. This approach is similar to that used by most states (e.g., California, Kansas, New York) attempting to implement innovative programs to address substance abuse among welfare recipients. The key features of this typical approach are: front-line caseworkers conduct the screening, screening occurs for all recipients at the point of benefit determination, and there is a reliance on paper and pencil screening measures. We label this approach "generic screening."