Add Services for the Hard-to-Employ

Contrary to popular impression, the hard-to-employ (defined as long-term welfare recipient dropouts without recent work experience) are not increasingly dominating state caseloads. This is due, in part, to more generous welfare earnings disregards that have enabled more employable recipients to remain on the rolls longer and, in part, owing to tougher sanctioning policies that have pushed some of the hardest-to-employ off the welfare rolls. To make further progress in reducing welfare caseloads, states will have to develop effective programs to overcome the barriers to employment of the hard-to-employ. Thus, as caseloads have fallen and as the five-year time limit approaches, states increasingly find themselves working with people who have a range of persistent, multiple, and, sometimes, severe employment barriers, such as substance abuse and depression, that make it difficult for them to get and keep a job. For example, three surveys of current and former welfare recipients conducted in 1999 found that 40 percent to 50 percent had less than a high school education, 20 percent to 40 percent had physical health limitations, and 30 percent to 40 percent had a serious mental health problem (primarily depression). The incidence of substance abuse problems was also significant, but prevalence rates were lower in these samples - between 6 percent and 8 percent. (These rates may be understated, since it is very difficult to obtain reliable information on drug use through self-report surveys.)

Each of these barriers poses distinct challenges for program design - challenges that are greatly exacerbated when barriers co-occur. A 1999 national survey found that 78 percent of welfare recipients experienced one barrier to employment, 44 percent experienced two or more barriers, and 17 percent experienced three or more barriers. Traditionally, programs for the hard-to-employ have been highly specialized and not well suited to address the needs of people with dual diagnoses or multiple problems. The severity and persistence of a condition are also critical factors in determining how a barrier will affect employment.

The knowledge base about effective programs for the hard-to-employ is only now being built. Traditional welfare-to-work programs do help some of the hard-to-employ raise their earnings, but average earnings were still woefully inadequate (about $1,000 per year on average). In addition, there is encouraging evidence in the disability field that supported-employment models can help individuals with severe and persistent disabilities move into jobs. And in the medical field, controlled studies have demonstrated the efficacy of mental health and substance abuse treatments for the general population. Still, very little is known about the effectiveness of these interventions for a low-income welfare population of single mothers or about their effectiveness when they operate on a large scale.

While investments in research, demonstration, and evaluation are essential to build additional knowledge about what works, it is clear that treatment programs for the hard-to-employ will play an important and growing part in states' efforts to reduce welfare caseloads further. If engagement in these activities does not count toward meeting their participation requirements, state officials have less incentive to work with these populations. Recognizing this need, the Bush administration's plan would allow engagement in treatment programs to count toward the participation standard, but only for 3 months out of every 24. Experience to date suggests that this is an inadequate amount of time to overcome the barriers faced by some welfare recipients.

Several studies from the substance abuse field provide support for this conclusion. A national study of substance abuse treatment called DATOS followed 3,000 patients in different treatment modalities. The study concluded that a three-month treatment episode was the minimum needed for patients to derive meaningful and sustained benefits. Patients who stayed in treatment for up to six months had significantly better outcomes than those receiving treatment for three months or less. In addition, studies indicate that the risk of relapse decreases significantly after about six months. Moreover, one study found that the odds of working increased greatly for each month of treatment duration: Recipients remaining in treatment for more than one year were nearly twice as likely to work than those who remained only for three months. In addition to these research results, anecdotal evidence suggests that in drug treatment programs serving substance-abusing women with children, the first three months are often spent dealing with addiction issues and detoxification. This suggests that between 6 and 12 months in treatment are necessary to give these women the resiliency skills they need to prepare them for remaining in recovery, holding a job, and being a parent. While the length of treatment will vary depending on the needs of individuals, and most will not require (nor will states allow) longer treatment than is necessary, the decision about when treatment should end and employment should begin is best based on the progress of the individual client rather than on an arbitrary time limit. Back to summary of policy implications