Mary Hanley Ramsey County, Minnesota May 30, 2007

1. Identifying TANF Recipients with Disabilities and Cognitive Limitations:Step 1 – Recognizing “Red Flags” Mary Hanley Ramsey County, Minnesota May 30, 2007

2. Introduction • Using special short-term funding from the state, Ramsey County created a special program to identify and address the needs of families nearing the five-year time limit; also to identify those who should be granted a hardship extension. • Lessons learned can be applied to the full TANF case load, not just those who have been on for long periods. • We believe that people with barriers, and even disabilities can work, but they may first need the safety net income SSI provides, and/or more and different types of support and accommodations to obtain and retain jobs.

3. What We Learned in Ramsey County • Participants don’t easily disclose learning problems and mental illness to their job counselors - or acknowledge them to themselves. • Subsequently, serious problems go undiagnosed and untreated. • Between 60-85% of the people we originally sanctioned were later found to be disabled, or were caring for a disabled family member. • Typical screening tools and even thorough psych assessments don’t uncover all the issues. • Functional assessment in the home is enormously helpful. Donna Pavetti:

4. Ramsey County Hardship Extensions Recent numbers indicate1360 hardship extensions of TANF benefits beyond the 5 year time limit. • 32% have IQs below 80. • 21% are caring for seriously ill family members. • 20% are ill and incapacitated, including SPMI. • 15% have a diagnosis of mental illness. • 5% have Specific Learning Disabilities. • 3% are employed but not earning enough to achieve self-sufficiency • 2% have family violence plans • 2% are deemed unemployable due to a combination of barriers, none serious enough to warrant hardship extension on it’s own, but in combination meet criteria for hardship extension • Those with hardship extensions represent 15% of Ramsey County residents currently receiving TANF funds. This number is cumulative.

5. About Those Numbers • Program rules require selection of one primary reason for extension only. • These numbers reflect the primary reason for extension, not all the reasons that could qualify a family. 3/4 of the participants I’ve worked with have several reasons for extension, so for instance, a person may have IQ below 70, mental illness, domestic violence in the home and be caring for special needs children all at the same time, and these numbers don’t reflect that.

6. The Big Question ?? If this TANF participant is disabled…. How have they managed to live in the community this long without difficulty???

7. The Answer They Haven’t!!! • Can’t read, so they don’t open their mail and consequently don’t respond appropriately to people, agencies, services, etc that rely on written correspondence…Including us! • Regularly victimized by landlords and others. • Evictions, utility cut offs due to poor reading and money management skills. • Extremely poor health care for themselves and their children - use ER for health care instead of scheduling visits at a clinic.

8. Recognizing Potential ProblemsThe Usual Process Brief screening tools, although helpful for some, don’t uncover many issues. Why? • Subjective • Require self disclosure • Disabled participants overestimate their abilities and minimize their struggles. • They internalize society’s messages about “welfare families” and want to separate themselves from those perceived as abusing “the system.”

9. How We Decided to Look Deeper……

10. Triaged Long Term Families Looked at history to identify red flag indicators in several areas for which we regularly collect information: • Employment • Education • Family Composition • Use of Social Services • Legal Involvement

11. Red Flag Indicators Involvement with Employment Services: • Lengthy stays of more than 2 uninterrupted years on TANF or… • A history of repeatedly losing jobs leading to a revolving door on TANF • Sanction history with no attempts to cure or repeated Sanctions • History of no shows for appointments • Failure to respond to mail and inability to reach by phone

12. Red Flag Indicators Work History • No work in past year • Many short term, failed work attempts • History of low wage jobs • Failure to complete training programs • Jobs ending due to poor attendance, poor interpersonal skills, and/or problems with pace, persistence and concentration • Sanction History with Employment Services

13. Red Flag Indicators Education History • No high school diploma or GED • Dropped out of school before age 16 • Many failed attempts to pass GED tests • History of attending special education classes • Failure to learn English in 2 years for English Language Learners

14. Red Flag Indicators Family History • Several children at an early age • Currently sanctioned with preschool age children • Involvement with Child Protection • One or more family members on SSI

15. Red Flag Indicators Social Service History • Currently homeless or history of homelessness • Doubling up with family members • Regular use of emergency funding • Involvement in other county administered programs such as case management for parents or children • History of treatment for substance abuse or mental illness

16. Red Flag Indicators Criminal History Look for these in combination with red flags in other areas, such as education and social services. • History of Felony Convictions. • History of Misdemeanors. If considering a home visit, make sure you are aware of any history of violent crimes.

17. What is Behind Some of These Red Flags? When we further assessed participants with red flags we found marked impairments in ability to perform activities of daily living, poor social functioning, and impairment in concentration, persistence and pace for employment related tasks due to the following disabilities: • Serious and Persistent Mental Illness, such as, Schizophrenia, Bi-Polar Disorder, Major Depression • Anxiety Disorders such as Post Traumatic Stress Disorder, Generalized Anxiety, Obsessive Compulsive Disorder, Social Anxiety, and Agoraphobia • Developmental Delay, ADHD, LD • Traumatic Brain Injury • Personality Disorders that interfere with behavior on the job.

18. We found long term participants had many of these Red Flags….. So….We started in depth assessment to gather more information….will provide more information in the next call on how we did those assessments … I’ll leave you with an example of how paying attention to red flags led to a successful outcome for a family that was about to have their case closed for non-compliance

19. One Family’s Story Participant was about to be closed and the following red flags were noted in her employment services file: • Dropped out of HS before age 16, no GED. • Several children at an early age. • History of repeated sanctions. • One child in special education classes. • Repeated episodes of homelessness. • No job in past years, short term work attempts.

20. Interventions and Outcomes • Performed an in home functional needs assessment. • Found evidence to support undiagnosed, untreated SPMI. • Established ongoing mental health treatment. • Applied for and was placed in long term family housing program for heads of household with MI. • Advocated for and got SSI approved. • Participant, who always had a goal to work, began working part time and has been able to keep her job for years, with occasional support.