Eileen P. Sweeney Center on Budget and Policy Priorities 820 First St, NE, Suite 510

1. Welfare Reform: Implications for TANF Recipients with DisabilitiesWebcast on Welfare and DisabilityJanuary 21, 2004 Eileen P. Sweeney Center on Budget and Policy Priorities 820 First St, NE, Suite 510 Washington, DC 20002 202-408-1080 fax 202-408-1056 sweeney@cbpp.org www.cbpp.org

2. What we know about people with disabilities and TANF • The ADA and Section 504 apply • What’s happening in Washington? • Talking about TANF and disability

3. I. What we know about people with disabilities and TANF • The Urban Institute’s national survey of current welfare recipients found: • 48 percent had either poor general or mental health, with 25% reporting poor general health and 35% reporting poor mental health. • Overall, for 32 percent either their health limited their work or they were in very poor mental health, with 18% reporting that their health limits work and 22% reporting very poor mental health.

4. There is a high incidence of people with mental impairments among parents on and off of TANF • National information from the Urban Institute • over one-third of current recipients scored low on a standard mental health scale while close to one-fourth scored in very poor mental health • approximately one-fifth of former recipients who were not working scored very poor on the mental health scale, placing them in the bottom 10 percent nationwide

5. The General Accounting Office has confirmed that high numbers of parents on TANF have disabilities • 44 percent of TANF recipients reported having physical or mental impairments, a proportion almost three times as high as among adults in the non-TANF population • 38 percent of TANF recipients in 1999 reported an impairment severe enough that the individual was unable or needed help to perform one or more activities, such as walking up a flight of stairs or keeping track of money and bills.

6. GAO confirmed high numbers of parents with mental impairments on TANF • “Considering both severe and nonsevere impairments, 29 percent of TANF adults reported a mental impairment, such as frequent depression or anxiety or trouble concentrating.” • GAO notes that self-reporting probably results in underestimates of mental impairments and “hidden” impairments such as learning disabilities.

7. GAO report: Welfare Reform: More Coordinated Federal Effort Could Help States and Localities Move TANF Recipients with Impairments Toward Employment, GAO-02-37, October 2001, available at http://www.gao.gov, under November 1, 2001

8. In a second report, GAO provided some additional information: • Recipients with impairments are half as likely to exit TANF as recipients without impairments. • People with impairments are less likely than people without impairments to be employed after leaving TANF. Some receive SSI, while others do not.

9. Overall, 44 percent of TANF recipients had impairments or were caring for a child with impairments, compared with 15 percent of the non-TANF population. • Fifteen percent of TANF families with an adult recipient had a child with a disability, compared to three percent of the non-TANF population. • Eight percent of TANF families had both an adult and a child with disabilities. (Among non-TANF families, this figure is one percent.)

10. In their first month after leaving TANF, 36 percent of leavers with impairments reported having no personal or household earnings, or SSI, compared with 23 percent of leavers without impairments.

11. GAO report: Welfare Reform: Outcomes for TANF Recipients with Impairments GAO-02-884, July 2002, available at http://www.gao.gov

12. MDRC findings • Based upon research in four large urban counties: Cuyahoga County, OH; Los Angeles, CA; Miami-Dade, FL; and Philadelphia, PA

13. MDRC: Compared with national samples, women in the survey sample had substantially higher rates of personal health and mental health problems and children’s health problems.

14. On a scale indicating the number of potential health barriers to employment (out of eight specific health problems), three out of four women in the survey sample had at least one such barrier, and 40 percent had two or more health problems.

15. MDRC also found that the data “do not fully capture the severity of the health-related hardships the families face.” • In addition, about 20 percent of current welfare recipients in the survey sample indicated that they had one or more children with a health problem.

16. MDRC report: Denise F. Polit, Andrew S. London, John M. Martinez, The Health of Poor Urban Women: Findings from the Project on Devolution and Urban Change, May 2001 http://www.mdrc.org/WelfareReform/UrbanChangepage.htm

17. The Urban Institute has found that “[p]erhaps the strongest predictor of not participating in work activity is the presence of multiple obstacles.” Loprest and Zedlewski, Current and Former Welfare Recipients: How Do They Differ? Urban Institute, Discussion Paper 99-17, November 1999 http://www.urban.org/html/discussion-99-17.html

18. Some parents with disabilities have been sanctioned off of TANF • As many as one-fourth to one-half of parents who are no longer receiving TANF due to a sanction for failure to comply with the state’s welfare rules indicate that they were unable to comply with the rules because of their disability, health condition, or illness. • The studies suggest that others who face learning disabilities or who have a low IQ find it difficult to understand and comply with the program’s rules.

19. More from MDRC: • “Negative experiences with the welfare agency were more prevalent among women with health problems.” • “Welfare recipients with multiple health problems and with certain health problems (notably, physical abuse, risk of depression, having a chronically ill or disabled child) were more likely than other recipients to have been sanctioned in the prior year.”

20. “Welfare leavers with multiple health problems were more likely than other women who had left welfare to say that they had been terminated by the welfare agency rather than that they left of their own accord.”

21. Studies in Utah and Delaware suggest that parents who face learning disabilities or who have low intelligence find it difficult to understand and comply with the program’s rules. • One-third of the families who were sanctioned in Utah, thereby losing their family’s entire cash benefit, cited an individual health condition as the reason for their failure to participate; one-fifth cited mental problems.

22. In Iowa, one-fifth of parents who were placed in the state’s limited benefit plan a second time – the plan in which families that have not complied with program rules receive a reduced benefit (akin to a sanction) – said that their disability/health contributed to their being returned to the sanction status, while almost three out of ten cited their lack of understanding of program rules. • Chronic health conditions identified as contributing to being placed in the program included drug addiction, manic depression, and chronic asthma.

23. A study conducted by the Minnesota Department of Human Services found that sanctioned families were four times as likely as the caseload as a whole to have a substance abuse problem, three times as likely to have a family health problem, twice as likely to have a mental health problem, and twice as likely to have been a recent victim of domestic violence.

24. Children in sanctioned families • A study in three cities – Boston, Chicago, and San Antonio – found that children in sanctioned families are more likely to have behavior problems and emotional problems than children in other families on welfare or who never received welfare.

25. The researchers concluded: “We need to attend much more carefully to the plight of families experiencing welfare sanctions. Sanctioned families have a number of characteristics that serve as markers of concern for the healthy development of children and youth. As such, state and federal governments should explore options for identifying and reaching out to the most disadvantaged and high-risk families involved in the welfare system.”

26. “Possible policy options include assistance to bring families into compliance with rules before they are sanctioned, closer monitoring of sanctioned families, and the provision of additional supports, such as mental health services, academic enrichment, after-school programs, and other family support services.”

27. Source: Chase-Lansdale, Coley, Lohman, et al., Welfare Reform: What About the Children? Welfare, Children and Families: A Three-City Study, Policy Brief 02-1, Johns Hopkins University, 2002 http://www.jhu.edu/~welfare/19382_Welfare_jan02.pdf

28. A medical study issued in 2002 additional information about young children in sanctioned families. • Study looked at the impact of sanctions on the health of infants and toddlers. • Study was done in six US cities from 8/98 through 12/00: Baltimore, Boston, Little Rock, Los Angeles, Minneapolis, and Washington, DC.

29. Households with children aged 36 months or younger whose welfare benefits had been terminated or reduced by sanctions had odds of being food insecure 1.5 times as great as comparable households whose benefits were not decreased. • Young children in families whose welfare benefits had been terminated or reduced by sanctions had 1.3 times the odds of having been hospitalized since birth.

30. Conclusion: “Terminating or reducing benefits by sanctions, or decreasing benefits because of changes in income or expenses, is associated with greater odds that young children will experience food insecurity and hospitalizations.” Source: Children’s Sentinel Nutrition Assessment Program, The Impact of Welfare Sanctions on the Health of Infants and Toddlers, July 2002, Arch Pediatr Adolesc Med, Vol 156, 678-683, available at: http://dcc2.bumc.bu.edu/csnappublic/welfaresanctions.htm

31. TANF programs serve many families with severe disabilities — policies need to be responsive to this important fact • At the beginning of welfare reform, “work first” approach • People labeled as “hard to serve” — welfare offices had simply exempted people in the past and then often ignored them. • Same folks that others — particularly organizations that have been working with people with disabilities — knew how to help to gain greater independence.

32. Over time, state TANF programs have tended to modify their “work first” approaches • Recognize that there are many people with barriers, including disabilities, on TANF • See people cycling back onto the rolls • Know that many who leave TANF are not working and do not receive SSI • Realize that many who are being sanctioned do not understand how to comply, the consequences of failing to comply, or have the ability to comply

33. In addition to pre-sanction review mechanisms, some states have been improving screening and assessment earlier in the process • Those that have done this — like Iowa — have found that fewer people are out of compliance and fewer people are being sanctioned.

34. II. States and counties are legally obligated to comply with the federal civil rights laws • Section 504 and the Americans with Disabilities Act (ADA) apply • Lest there be any question, the 1996 TANF law specifically incorporates the key federal civil rights laws.

35. Common goals of TANF and ADA/§504 dovetail • Success in complying with the ADA and Section 504 can create exactly the types of results Congress hoped for in TANF

36. HHS OCR Guidance on TANF and the ADA/§504 · Available at: http://www.hhs.gov/ocr/prohibition/html · Worth reading, re-reading, and sharing – provides helpful context for thinking about people with disabilities in TANF; also helpful information about best practices

37. Two key principles: • Individualized treatment • Effective and meaningful opportunity

38. Individualized treatment • Requires that individuals with disabilities be treated on a case-by-case basis consistent with facts and objective evidence • Individuals with disabilities may not be treated on the basis of generalizations and stereotypes.

39. Effective and meaningful opportunity • Individual with disabilities must be afforded the opportunity to benefit from TANF programs that is as effective as the opportunity the TANF agency affords to individuals who do not have disabilities, and must also be afforded “meaningful access” to TANF programs.

40. To implement these two principles, there are 3 key legal requirements: • Ensure equal access through the provision of appropriate services • Modify policies, practices and procedures to provide such access • Adopt non-discriminatory methods of administration

41. When thinking about the rules, it is important to remember that they apply not only to a person with disabilities who is the caretaker relative, but also to family members with a disability.

42. These rules should be infused into everything the TANF agency, its agents, and contractors do.

43. These rules apply no matter what position the person holds: • Policy maker/policy implementer • Office manager/supervisor • Case worker • Receptionist • Security officer

44. The person who designs the state’s or county’s notices and signage • Vocational specialist • Trainer/trainee • Contract procurement specialist

45. And, also more globally in how the office functions: • In the contents of notices • In the signage about rights • In the terms included in contracts with private providers or other public agencies to provide services • In how the agency thinks about each and every policy it has that affects the people the agency serves and their families.

46. The important role of reasonable accommodations • Must happen at different levels — built into policies • Staff must have the ability to design accommodations on a case-by-case basis, taking into account the individual’s disability.

47. Contractors must know that they can make the changes needed to serve the person with a disability — and that the state or county will pay them. • Important to consult with the person to see what he or she thinks will work — what he or she needs to succeed.

48. What kinds of steps are reasonable accommodations? • Allowing an individual to do work activities part-time, or during flexible hours. • Providing support services such as equipment, a job coach, or tutor. • Placing a person in “inactive status” if necessary to allow the individual to participate in health, mental health, or substance abuse treatment or rehabilitation services, if the individual chooses to do so.

49. Providing the individual with work activities in a specific work environment (including indoor work, work in a quiet area) that enables the individual to participate in work activities • Providing the individual with particular types of jobs or work activities that are consistent with the individual’s limitations, such as work that requires limited standing or lifting, or that involves limited contact with the public.

50. Clients must be allowed to do things at different times/places or for a different amount of time when needed because of a disability. Some examples: • If the person has a disability and can’t come to the agency for the application interview, a home visit must be provided. • Allowing a client to reschedule a fair hearing when there is good cause (including a disability-related reason)