The Temporary Assistance to Needy Families Substance Abuse and Mental Health (TANF SAMH) Program provides non-medical services to Welfare Transition Program (WTP) - formerly known as WAGES - participants with mental illness and/or substance abuse impairments that create barriers to family stability and economic self-sufficiency. In Florida, publicly funded substance abuse and mental health services are provided by two parallel systems: one serves persons with substance abuse-related disorders and the other serves persons with mental illnesses. Through TANF SAMH, the two systems participate in ongoing collaboration to further advance the responsiveness and accessibility for Florida's citizens.

The goals of the two systems are simple and straightforward. Substance abuse services are to promote healthy, abusive-free, substance-free lifestyles with improved functionality including economic self-sufficiency. These services are targeted to children, adults, and their families who have or are suffering from the negative effects of substance abuse-related disorders. This includes prevention services for those children who are at risk for substance abuse problems.

The goal of the mental health system is to provide care, in partnership with families and the community, that enables children and adults with mental health problems or emotional disturbances to successfully live in the community, to be self-sufficient or to attain self-sufficiency at adulthood, and to realize their full potential.

Florida's publicly funded mental health and substance abuse services are organizationally located in the Department of Children and Families. In addition, the department is responsible for the state's economic and self-sufficiency services, family safety services, adult services, and developmental services.

The department's central offices are responsible for statewide policy, rule promulgation, program development, strategic planning, and oversight of programs. Visit the Department of Children and Families, Alcohol, Drug Abuse, and Mental Health Program Office website at: www.state.fl.us/cf_web/adm. Service delivery for all programs is the responsibility of the department's 15 service districts.

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The TANF SAMH Program

The TANF SAMH Program provides screening, assessment, case management, and treatment services to those persons who are having employment and family instability due to mental illness and/or substance abuse impairment.

TANF Goals

TANF SAMH services must directly support the achievement of at least the first two of the four TANF goals. These goals, as stated in federal legislation, are:

1. Provide assistance to eligible families so children may be cared for in their own homes or in the homes of relatives.

2. End the dependence of needy parents on government benefits by promoting job preparation, work, and marriage.

3. Prevent and reduce the incidence of out-of-wedlock pregnancies and establish annual numerical goals for preventing and reducing the incidence of these pregnancies.

4. Encourage the formation and maintenance of two-parent families.

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TANF Program Participants

The TANF SAMH Program serves two groups of participants:

1. Temporary Cash Assistance (TCA)
2. TANF Diversion Family Population (TDF)

The substance abuse and mental health programs have established "target populations" that will be served with its limited resources. These target populations are:

1. Children with mental health and substance abuse problems
2. Children incompetent to proceed in Juvenile Justice
3. Children with serious emotional disturbance
4. Children with emotional disturbance
5. Children at risk of an emotional disturbance
6. Children with substance abuse problems
7. Children at risk of substance abuse problems
8. Adults with substance abuse problems
9. Adults with a serious and persistent mental illness in the community
10. Adults in mental health crisis
11. Adults with forensic involvement
12. Adults in civil commitment
13. Adults in forensic commitment

The TANF SAMH population is incorporated within the existing SAMH target populations. The TCA population has priority to available TANF allocations and services over the TDF population.

Temporary Cash Assistance (TCA) Population

As a result of the Temporary Assistance to Needy Families (TANF) legislation, the substance abuse and mental health service system is TANF funded for serving persons who are applicants for or recipients of TCA assistance. Also, persons who have been referred for mental health or substance abuse services based on the eligible recipient's request for services or because of an indication from a screening and assessment, it was determined the recipient would benefit from such services. When a person applies for TCA benefits, the person must be determined eligible or not eligible based on federal/state criteria. During the eligibility determination phase, the person will also be interviewed to determine if any substance abuse or mental health services are requested or needed.

TANF SAMH Treatment Flow Chart
TANF SAMH Treatment Flow Chart - PDF Version (11K)

Referral Criteria

• Referral Criteria

  The TANF SAMH Program referral criteria for TCA participants are:

  TCA Participant type includes:

  1. The individual must be an applicant for or a recipient of temporary cash assistance; or

  2. A family member, as defined in s. 414.0252, F.S., when impairment has a direct impact on the needs of the TCA participant; or

  3. Post-TANF recipient within 12 months following TCA eligibility; or

  4. Child-only case as defined in s. 414.045(1)(b), F.S.

  and

  Individual or family member must be identified as having a barrier to employment stability due to substance abuse and/or mental health impairments;

  and

  Eligibility for TANF SAMH Services excludes those who are SSI recipients.
  (an individual who volunteers for work activity may receive services consistent with such participation)

  TANF SAMH Diversion Family Population (TDF)

  TANF SAMH Diversion Families are those that meet the WTP income requirement and are at risk of becoming WTP participants due to economic instability because of substance abuse and/or mental illness problems. Families that are identified as the TANF SAMH Diversion Family population are eligible for the TANF SAMH Program that incorporates a focus on family and employment stability. The treatment plans include goals that address caring for children in their own homes or relatives' homes and assisting families in becoming self-sufficient. According to s.414.1585, F.S., these families are eligible to receive the same services as the TCA population.

• Referral Criteria

  The TANF SAMH Program referral criteria for TDF participants are:

  1. Parent(s) or relative caretaker with one or more minor children living in the home; or

  2. A pregnant woman; or

  3. Families whose children have been removed from the home by the Family Safety Program (FSP) may also be treated for substance abuse and/or mental health under the TANF SAMH Program as long as said treatment is included in or added to the active family reunification goal in the case plan; or

  4. Non-custodial parent with a court order to pay child-support; or

  5. SSI/SSDI family with work directive goals;
  
  and

  Family who is at risk of becoming welfare dependent due to substance abuse or mental illness problems;
  

  and

  Family income is below the 200% of the federal poverty level (see TANF Income Eligibility Guidelines) and there is documentation of income in the SAMH agency's record.

The TANF diversion family population has an eligibility factor allowing non-custodial parents who have a court order to pay child support to receive TANF services. This provision is designed to make sure that children receive child support from their non-custodial parents and those parents get the services they need in order to stay in the workforce.

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The following non-medical services are eligible for TANF reimbursement. Definitions of these services are derived from the Mental Health and Substance Abuse Measurement and Data Handbook, 1st Edition, May 2000:

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Aftercare

Assessment Services

Case Management Services

Crisis Support/Emergency Services

Day Care Services

Day-Night (Day Treatment) Services

In-Home & On-Site Services

Intensive Case Management Services

Intervention Services

Outpatient Services

Outreach Services

Prevention/Intervention Day Services

Residential Treatment Levels 1-4

Respite Care

Sheltered Employment

Supported Employment

Supported Housing/Living

TASC (Treatment Alternatives for Safer Communities)

Not eligible as a TANF service*

Descriptions for the ineligible TANF services can be found in "A Guide to Performance Contracting for Alcohol, Drug Abuse, and Mental Health Services", May, 2000, 6th Edition.

1. Crisis Stabilization
2. Drop-In/Self-Help Centers
3. Information & Referral
4. Inpatient
5. Medical Services
6. Methadone Maintenance
7. Prevention (universal)
8. Substance Abuse Detoxification Services

Eligible TANF SAMH
Services Descriptions

Aftercare, including but not limited to relapse prevention, is a vital part of recovery in every level of treatment. Aftercare activities include client participation in daily activity functions that were adversely effected by mental illness and/or substance abuse impairments. New directional goals like vocational education or rebuilding relationships are often priorities. Relapse prevention issues are key in assisting the client to recognize triggers and warning signs that one may be regressing. Aftercare services help families and pro-social support systems reinforce a healthy living environment for the client.

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Assessment Services assess, evaluate, and provide assistance to individuals and families to determine level of care, motivation, and need for services and supports to assist individuals and families to identify their strengths.

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Case Management Services consist of activities aimed at identifying the recipient's needs, planning services, linking the service system with the person, coordinating the various system components, monitoring service delivery, and evaluating the effect of services received.

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Crisis Support/Emergency Services are nonresidential care services, generally available 24 hours, 7 days a week or some other specific time period, to intervene in a crisis or provide emergency care. Examples include mobile crisis, crisis support, crisis/emergency screening, crisis telephone, emergency walk-in, and assertive community treatment.

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Day Care Services provide a structured schedule of activities for four or more consecutive hours per day for children of persons who are participating in a substance abuse day - night service.

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Day/Night (Day Treatment) Services provide a structured array of nonresidential services for four or more consecutive hours per day. Activities for children and adult mental health programs are designed to assist individuals to attain skills and behaviors needed to function successfully in living, learning, work, and social environments. Generally, a person receives three or more services a week. Activities for substance abuse programs emphasize rehabilitation, treatment, and education services using multidisciplinary teams to provide integrated programs of academic, therapeutic, and family services.

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In-home and On-Site Services are therapeutic services and supports that are rendered in non-provider settings such as nursing homes, adult congregate living facilities, residences, schools, detention centers, commitment settings, foster homes, and other community settings.

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Intensive Case Management Services consist of activities aimed at assessing recipient needs, planning services, linking the service system to a recipient, coordinating the various system components, monitoring service delivery, and evaluating the effect of services received. These services are typically offered to persons who are being discharged from a hospital or crisis stabilization unit who are in need of more professional care and who will have contingency needs to remain in a less restrictive setting.

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Intervention Services focus on reducing risk factors generally associated with the progression of substance abuse and mental health problems. Intervention is accomplished through early identification of persons at risk, performing basic individual assessments, and providing supportive services that emphasize short-term counseling and referral. These services are targeted toward individuals and families.

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Outpatient Services provide a therapeutic environment that is designed to improve the functioning or prevent further deterioration of persons with mental health and/or substance abuse problems. They are usually provided on a regularly scheduled basis by appointment with arrangements made for nonscheduled visits during times of increased stress or crisis.

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Outreach Services are provided through a formal program to both individuals and the community. Community services include education, identification, and linkage with the high-risk groups. Outreach services for individuals are those of encouragement, education, and engagement for prospective clients who show an indication of substance abuse and/or mental health problems or needs. Note: Client enrollment is not included in Outreach Services.

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Prevention/Intervention Day Services include school-based day services for children and adolescents for four or more consecutive hours per day. It includes:

For children with mental health problems, these services include school-based mental health services for children who have been identified by the school as having or are at risk of developing mental health problems. Services are individualized and may be provided in a self-contained classroom, a regular classroom, or as a component of a full service school.

For children and adolescents with substance abuse problems, it includes Alpha and Beta targeted prevention programs serving students in grades 4-6 and 6-8, respectively, who are identified as at risk for alcohol or other drug abuse. Targeted prevention consists of multiple, structured contacts over time to specific individuals or groups identified as having behavioral, biological, or environmental at-risk characteristics. These programs are designed to promote skills building and reduce the risk of establishing patterns of use. Services are provided through community provider agencies in partnership with county school boards. Counselors provide individual, group, and family counseling and school personnel implement an intensive education program.

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Residential Levels

• Residential Level 1 Services are licensed services which provide a structured, live-in, a non-hospital setting with daily 24 hour supervision. There is a nurse on duty in these facilities at all times. For adult mental health, these services include two different kinds of programs: Group homes and short-term residential treatment services. Group homes are for longer-term residents. These facilities offer nursing supervision provided by, at a minimum, licensed practical nurses on a 24 hours a day, 7 days per week basis. Short-term residential treatment services provide intensive residential treatment for individuals in need of acute care for an average of 90 days. For children with serious emotional disturbances, Level 1 services are the most intensive and restrictive level of residential therapeutic intervention provided in a non-hospital setting which include residential treatment centers and short-term residential treatment programs. On-call medical care must be available for substance abuse programs. Level 1 provides a range of assessment, treatment, rehabilitation, and ancillary services in an intensive therapeutic environment, with an emphasis on treatment, and may include formal school and adult education programs.

• Residential Treatment Level 2 Services are licensed structured rehabilitation-oriented group facilities that have 24 hour, seven days per week supervision. Level 2 facilities are for persons who have significant deficits in independent living skills and need extensive support and supervision. For children with serious emotional disturbances, Level 2 services are programs specifically designed for the purpose of providing intensive therapeutic behavioral and treatment interventions. This includes therapeutic group homes, specialized therapeutic foster homes-Level II, and individualized residential treatment homes. For substance abuse, Level 2 provides a range of assessment, treatment, rehabilitation, and ancillary services in a less intensive therapeutic environment with an emphasis on rehabilitation and may include formal school and adult educational programs.

• Residential Treatment Level 3 Service facilities are designed to provide 24 hours, 7 days per week supervised residential alternatives to persons who have developed a moderate functional capacity for independent living. For children with serious emotional disturbances, Level 3 services are programs specifically designed for the purpose of providing sparse therapeutic behavioral and treatment interventions including therapeutic group homes, specialized therapeutic foster homes-Level I, and individualized residential treatment homes. For adults with serious mental illness, this cost center consists of supervised apartments. For substance abuse, Level 3 provides a range of assessment, rehabilitation, treatment, and ancillary services on a long-term, continuing care basis where, depending upon the characteristics of the clients served, the emphasis is on rehabilitation or treatment.

• Residential Level 4 Service facilities may have less than 24 hours per day, 7 days per week on-premise supervision. This is the least intensive level of residential care. It is primarily a support service and, as such, treatment services are not included in this cost center. For adult mental health, this includes satellite apartments, satellite group homes and therapeutic foster homes. For substance abuse, Level 4 provides a range of assessment, rehabilitation, treatment, and ancillary services in a transitional living environment with an emphasis on habilitation and rehabilitation. For children with serious emotional disturbances, Level 4 services are the least intensive and restrictive level of residential care provided in group or foster home settings, therapeutic foster homes, and group care with treatment. Note: Regular therapeutic foster care can be provided either through Residential Level 4 "Day of Care: TFH" or by billing in-home/non-provider setting for a child in a foster home.

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Respite Care

Service is an organized program that is designed to sustain the family or other primary care giver by providing time-limited, temporary relief from the ongoing responsibility of care giving.

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Sheltered Employment

Service is noncompetitive employment within a work-based facility.

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Supported Employment

Service is community-based employment in an integrated work setting that provides regular contact with non-disabled co-workers or the public. A job coach provides long-term, ongoing support for as long as it is needed to enable the person served to maintain employment.

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Supported Housing/Living

Services assist persons with substance abuse and psychiatric disabilities in the selection of housing of their choice and provide the necessary services and supports to assure their continued successful living in the community and transition into the community. For children with mental health problems, supported living is the process of assisting adolescents in arranging for housing and providing services to assure successful transition to living on their own or with roommates in the community. Services include training in independent living skills. For substance abuse, services provide for the placement and monitoring of recipients who are participating in nonresidential services and persons who have completed or are completing substance abuse treatment and need assistance and support in independent or supervised living within a live-in environment.

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TASC (Treatment Alternatives for Safer Communities)

provides for identification, screening, court liaison, referral, and tracking of persons in the criminal justice system with a history of drug abuse or addiction.

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