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—Nolia Brandt, M.S.W., M.A., A.C.S.W., C.E.A.P.

First and foremost, welfare reform is about economics. National and State welfare reform is taking place within a broader economic environment. Welfare reform is being driven by the same business trends as the economy as a whole—rapid technological change, downsizing, globalization, America's shift from manufacturing to information and service industries, and the movement toward a contingency workforce with few or no benefits and little job security. Welfare recipients entering the workplace will confront the same concerns and challenges as other American workers and their families: getting and keeping a job in a competitive climate.

What employers will continue to want most are workers who show up on time, are able to follow verbal instructions, are able to get along with others, and are drug free. But behavior and health factors contribute to three problems facing workers or their family members: substance abuse, mental illness, and domestic violence. These affect job performance and may threaten the employability of a former welfare recipient. From the employer's point of view, these personal problems cause more than turnover and poor-quality work. According to the Office of National Drug Control Policy, untreated addictions cost American business from $50 to $100 billion each year in increased medical claims and disability costs from illness and injuries, theft, absenteeism, and decreased productivity; two-thirds of all drug abusers in America are in the workplace (President's Commission on Model State Drug Laws, 1993). Substance abuse prevention, intervention, and treatment systems must therefore become highly valued in the context of welfare reform and workplace productivity.

Service-sector jobs, in which many working poor will become employed, typically come without medical or leave benefits, without security either in continuity of employment or in the number of hours an employer makes available for working, and without employee assistance programs (EAPs). At the same time, substance abuse prevention and treatment services will be needed more than ever before. Unfortunately, welfare reform legislation passed in the absence of health care reform. This means that the ability of the working poor to get medical and other necessary services, such as those for substance abuse and mental health problems, will become more limited when they are needed most. The pressures on publicly funded treatment programs can be expected to grow as lifetime caps on welfare benefits are reached.

Treatment Reforms Accompany Welfare Reform

What do the changes in welfare mean to our populations and programs? First, work requirements in many States are even more stringent than those in the Welfare Reform Act. This means that extended residential treatment or strict on-campus requirements in publicly funded substance abuse treatment systems may need to be replaced with other treatment designs and options. Outpatient treatment services will need to be more flexible, available during nontraditional hours and in alternative settings. Women welfare recipients in treatment will have work requirements, as will their partners, men who may also be in treatment. Second, employment will increasingly become a focus in the treatment and aftercare environment, as it has in Ohio, Kansas, South Dakota, and Florida (see articles in this issue).

And third, substance abuse prevention and treatment will increasingly become necessary to help former welfare clients remain employed. Case management in the treatment setting will be needed to coordinate closely with the welfare and employment systems, and to deal effectively with relapse issues. Prevention will be directed toward adults at risk and their children. Programs can also be targeted to dependent children and family members of current and former welfare recipients. States with waiting lists for substance abuse treatment services will find the number of those in need of services is swelling.

The Importance of Employee Assistance Programs

Once welfare recipients who have completed treatment and found work enter the private sector, EAP services must be readily available to them, to employers, and to community service placements. Organizations that may have or use EAPs include large corporations, small businesses, unions, governmental organizations, and professional and occupational organizations. The EAP professional's scope is broad, and includes dealing with employees, supervisors, management, and the unions. Rather than mount an EAP within each firm, employers often form consortiums to purchase EAP services from those trained to deliver a complex menu of services.

The ultimate goal of EAPs is to reduce the social and economic costs that employee problems bring to the workplace. Originally designed to tackle alcohol and other substance abuse problems within a company or organization, EAPs have grown in breadth and flexibility. Now, many EAPs also help employees get help for financial, marital, interpersonal, legal, occupational, and other issues that affect job performance.

Other Resources for Reform
The expanded EAP approach to assisting employees with a range of personal dilemmas mirrors the trend in many States toward cross-departmental cooperation to provide clients with wraparound services. Many products and systems components will help public services, employers, and welfare recipients transition from welfare to work or from public to private systems. These resources should be used at multiple points in the welfare-to-work system: at initial contact, at jobs registration, at eligibility appointments, when an applicant finds employment (with or without full or partial "welfare benefits" for a period of time while working or doing community service), in the welfare system, in the workplace, and when individuals are terminated from welfare benefits, particularly for inability to get or maintain a job.

What resources are available to put these important system components into place? Medicaid should be the first line of payment for treatment services for welfare recipients and for those whose Medicaid benefits are extended for a period of time after employment. Although benefits for residential substance abuse treatment are excluded from Medicaid reim-bursement, some residential treatment providers are billing for medical, counseling, and other allowable services. Second, there is money for support services in Temporary Assistance for Needy Families (TANF) and through most States' legislation. Third, although most States have waiting lists for publicly assisted substance abuse treatment, there are Federal Sub-stance Abuse Prevention and Treatment (SAPT) block grant funds, for which women's and dependent children's services are particularly emphasized. In addition, primary prevention funds from the SAPT block grant could be used for prevention programs targeting welfare recipients, workers at risk, and their families.

There are also resources within family preservation and safety programs, juvenile and criminal justice systems, mental health programs for dually diagnosed, and labor and employment security systems.

Public Agencies Collaborate With Employers to Serve Clients

Welfare reform can work if the public substance abuse treatment, human services, and employment sectors collaborate with employers. A credible needs assessment is essential. To make sure that the number of people who may be coming into substance abuse treatment systems can be served, the following data would be helpful: