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For many current welfare recipients, substance abuse may pose the largest single obstacle in their ability to secure and keep jobs.   Substance Abuse and Mental Health Services Administration Public Health Service U.S. Department of Health and Human Services

We began this special TIE Communiqué on welfare reform by asking how Federal and State welfare reform efforts are affecting the substance abuse community. But as we talked to human services and substance abuse treatment and prevention professionals around the country, we quickly realized that the question needs to be turned around. Instead, we need to ask: What is the impact of substance abuse treatment on welfare reform? Quite simply, the success of welfare reform for up to 40 percent of former Aid to Families with Dependent Children (AFDC) heads of household and an unknown number of children depends on substance abuse treatment and prevention. For these welfare recipients and their families, substance abuse is a major barrier to getting and keeping a job. Treatment and wraparound services must be seen as an integral part of the welfare-to-work equation. To gain and sustain economic and social independence, welfare clients need our continued support. CSAT's mission is to help States make the transition from welfare to work possible for these families. In "The End of Welfare as We Know It," an overview of welfare reform, we examine the ramifications of Federal legislation on a full range of programs, from income assistance to Medicare and Medicaid. Many welfare clients are women and children, whose needs for substance abuse treatment and vocational training and assistance are as urgent as their needs for medical care, day care, and child and spousal abuse protective services. Our guest editorials analyze the welfare-to-work and substance abuse treatment connection from two points of view: policy and practice. In "Beyond Welfare Reform," Nancy K. Young and Sidney L. Gardner argue that we must seize the opportunity to demonstrate how much the substance abuse field can contribute to helping other social service systems achieve their goals, thus expanding the base for treatment services. Failure to do so, they contend, would constitute a failure of accountability to U.S. taxpayers.

Young and Gardner point out, in "Implications for Child Protective Services," that our Nation's most vulnerable young people will suffer most if agencies and departments that share the same clients do not abandon turf issues and attitudes that work against cooperation. The clocks are ticking, the authors warn, and unless we wake up before the alarms go off, children will suffer.

Nolia Brandt shows how treatment reforms must accompany welfare reform in her article, "Welfare Reform, Substance Abuse Treatment, and America's Workplaces." She delineates the continuum of practical services that welfare clients need as they move from welfare to work, broadening the discussion to include the role of private sector employers and employee assistance programs (EAPs). She suggests resources for reform and outlines how public agencies can collaborate with employers to serve clients.

"Vocational Services for Substance Abuse Treatment Clients" describes a NIDA-funded study of methadone programs that introduced an employment component. Since many methadone clients are also welfare recipients, the Training and Employment Program (TEP) focused on the knotty issues facing people in treatment and on public assistance. TEP custom-designed a vocational assessment/employment readiness instrument for these clients, plus a comprehensive manual for substance abuse and human service professionals on how to integrate employment services into treatment settings.

Substance abuse treatment not only works for welfare clients, it also saves taxpayers money, as our article "The Ohio Cost-Effectiveness Study" shows. This 4-year research effort corroborates what practitioners observe daily in the field: People who engage in substance abuse treatment are better able to get a job. Ohio's statistics prove it. The study also showed sizable cost offsets for all treatment types and levels of client severity.

We can get there from here. Whether from a policy or practice perspective, our contributors have drawn a map for achieving cooperation among Federal and State departments and agencies and the private sector.

From the policy perspective, the Clinton Administration and Congress have provided additional funding to support services for people transitioning from welfare to work. In "Welfare-to-Work Grants Available Through the Department of Labor," we describe the Employment and Training Administration's program to nurture the kind of collaboration our contributors discuss in this issue.

Practitioners' reports from the field are encouraging: Success is already happening. Our articles on welfare-to-work initiatives in California, Kansas, and South Dakota demonstrate the commitment and creativity of treatment and social services professionals throughout the country. Working together, they are imagining and facilitating independent futures for clients who have been dependent all their lives—on substances and on welfare assistance.

From California, Toni Moore reports on changes in Sacramento County's 

Department of Health and Human Services (DHHS). Saturated by substance abuse-related problems, the county's child welfare, mental health, public health, adult protective services, and primary health case-loads demanded an integrated approach. DHHS responded with Alcohol and Other Drug Treatment Initiatives, to incorporate substance abuse treatment services as an integral part of the health and human services system. DHHS workers have been trained to screen for substance abuse problems, with the goal of providing treatment on demand for clients.

Sharing information about substance abuse across departments and offering a comprehensive system of services have worked well in other States, too, as our articles on Kansas and South Dakota attest. Kansas Works, a pilot program that makes work readiness a focus for welfare clients seeking employment services, automatically screens for substance abuse and refers to State Regional Alcohol and Drug Assessment Centers. In South Dakota, the juvenile justice system is the point of entry for the Family Aftercare Program, an interdepartmental collaboration which provides families with multiple problems, including substance abuse, with intensive family services.

Although many of the programs that the States have initiated are new, the concepts underlying them are tried and true. Comprehensive services that include substance abuse treatment and prevention for clients involved in public social welfare agencies make good sense—and good dollars and cents. 

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