Encouraging Trust from Participants

A question was asked by a State representative at a recent OFA Regional Workshop: How do you encourage trust from participants to communicate freely on barriers such as substance use in order to best meet their needs? What promising methods do you use to endear that trust?
Record Type: 
Question / Response(s)
Date: 
September 2018
Source: 
OFA Peer TA
Agency/Organization: 
Anonymous
Topics/Subtopics: 
  • TANF Program Administration
    • Case Management

Comments

California
10 Oct, 2018

A representative from Robbin and Associates recommends one strategy to their client agencies: ask people who received substance abuse services from them to speak about how the agencies have helped them. These individuals can be included in orientations, where their comments can be videotaped and viewed during Job Clubs or individual counseling sessions. Also, agencies can ask individuals to call in and talk about the help they received that enabled them to move past substance use; role models are much more powerful than information in dealing with most barriers.

Agencies can also provide a list titled “Common Challenges We Help People Overcome,” which lists the most common barriers that are difficult for people to face on their own. Seeing these barriers on a list makes people realize that they are not alone, and that agencies have experience helping people with these challenges; this makes it easier to discuss barriers after agencies "normalize" them in this way. It is important to think of the process of opening up about a barrier as a gradual journey that can be helped along with role models, proactively raising the barrier, and nudges, as opposed to assuming that one conversation or point in time will get people to open up about the barrier.

Robbin and Associates
District of Columbia
05 Nov, 2018

A representative from the D.C. Department of Human Services explains that although D.C. does struggle with this issue, its TANF program is designed to provide services in a non-threatening environment, it meets customers where they are, and is focused on supporting rather than penalizing. The program provides staff training in strength-based interviewing, includes no time limit, and imposes a minimal sanction for non-participation of up to 6%. The program’s basic philosophy is based on a platform of trust and the belief that customers want to engage.

Department of Human Services
Washington
19 Dec, 2018

There are several ways that the Washington state TANF program encourages trust with WorkFirst participants so they feel safe to communicate about barriers such as substance abuse.

Each WorkFirst participant completes an orientation at application, during which we explain aspects of the WorkFirst program, including barrier removal activities such as family violence, mental health, and substance abuse treatment. Staff explain that we can develop a plan together to address these challenges, that this will count as part of a WorkFirst plan, and that we can provide supports such as child care and transportation while the participant engages.

Staff work with each WorkFirst participant to complete a comprehensive evaluation within 30 days of application that adopts a strength-based, whole family approach. During this assessment, participants discuss their challenges as well as their strengths. We ask about their children and also their goals, which helps build rapport between case manager and participant. The comprehensive evaluation was designed using the GAIN SS tool to discuss issues around substance abuse and allows the worker to address emergent issues up front before developing a work plan. The comprehensive evaluation also asks questions that might lead to conversations around substance abuse like transportation, work history, and legal issues.

We revisit the comprehensive evaluation at least yearly, which allows the participant to build a professional relationship and trust with the case manager and increases the chance they will be open about barriers including substance abuse issues.

Each of our WorkFirst staff are required to complete a Mental Health First Aid class which covers different mental health illness including substance abuse. This class helps staff identify an individual in crisis and how to connect them to services for assistance.

WorkFirst participants are referred to a social service specialist to complete an assessment if they are pregnant or with a child under two, or report significant challenges such as medical or mental health issues that would prevent them from participating in work activities. The assessment contains open-ended questions designed to allow the participant to share about their challenges. Some participants may not feel safe disclosing substance abuse issues at an intake interview in fear that it might somehow affect their eligibility for services. Since social services specialists do not determine eligibility for our TANF program, this might also help build trust with the participant to share additional barriers.

Washington state has a very close working relationship with our state partners: the State Board of Community and Technical Colleges, the Department of Commerce, and the Employment Security Department. These agencies work very closely with WorkFirst participants who are referred to their job search, work experience, and education programs. A participant may feel safe to disclose barriers around substance abuse as they work with these partners over weeks and months. In these cases, the partner agency connects with the case manager to complete a continuous activity plan meeting with the partner and participant; at these meetings, we can adjust the WorkFirst plan to include addressing substance abuse issues.

Still, some participants either are not ready to admit they have a substance abuse issue or do not feel safe disclosing this barrier. If a participant is struggling to follow through with their activities, we may schedule that family for an appointment to discuss why they are unable to participate. If the participant does not attend the appointment, we will try to contact them by phone, and if we still are unable to make contact, we complete a home visit. During this meeting, we discuss again any barriers that might prevent them from participating in their plan and explain that we can change their plan to address any new barriers reported, which provides participants another opportunity to disclose any substance abuse issues.

Washington state also has rules that help support families while a parent is participating in a treatment program: WAC 388-454-0015 “Temporary absence from the home” provides that we can continue cash assistance for a family for up to 180 days while the caregiver is out of the home receiving care in an inpatient substance abuse treatment facility. This allows the caregiver to receive the treatment they need without fear that they will lose the grant and be unable to support their children.

The Economic Services Administration (ESA) of the Department of Social and Health Services (DSHS) provides the TANF program and Behavioral Health Administration, which includes substance abuse treatment. Since substance abuse assessments and treatment are covered under the Washington Apple Health program and the Supplemental Security Income medical program, which covers the vast majority of WorkFirst participants, families reporting substance abuse issues can receive the help they need. The newly developed Department of Children, Youth, and Families (DCYF) (includes the former Children’s Administration) continues to work closely with the ESA to communicate on issues such as substance abuse treatment so we can provide appropriate services to families in need. If a family requires a substance abuse assessment or treatment, WorkFirst staff have access to those systems and coordinate WorkFirst activities to include requirements from DCYF.

Finally, our agency is looking at transforming the way we provide case management services. Transforming Case Management is a multi-year, cross-functional project. The project's goal is to build effective, standardized case management practices and a social service business delivery model. To accomplish this goal, the project evaluated findings from our Systems to Family Stability Policy Academy pilots, along with many other initiatives and research related to poverty mitigation strategies, and brain sciences; the project gathered information from customer-facing staff and the customers themselves. Our workgroups reviewed the information and made recommendations on how we might improve our service delivery to help move families into long-term self-sufficiency. Some of the 34 recommendations moving forward are:

  • Offer voluntary case management services and self-assessments to all recipients of all programs;
  • Expand and offer case management services for the whole family;
  • Train staff to use a coaching approach with individuals and families to identify their own self-defined goals and create a pathway to reach those goals; and
  • Make effective referrals to community resources.

Please let us know if you have any additional questions. We would be more than happy to elaborate on the above information or schedule a time to discuss these services.

Economic Services Administration/Community Service Division

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