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Identifying TANF recipients' substance abuse problems in four Colorado counties

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Title:
Identifying TANF recipients' substance abuse problems in four Colorado counties
Creator:
Moore, Elizabeth Ann
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English
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xiii, 166 leaves : ; 28 cm

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Doctorate ( Doctor of Philosophy)
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University of Colorado Denver
Degree Divisions:
School of Public Affairs, CU Denver
Degree Disciplines:
Public affairs

Subjects

Subjects / Keywords:
Welfare recipients -- Drug use -- Colorado ( lcsh )
Public welfare -- Colorado ( lcsh )
Public welfare ( fast )
Welfare recipients -- Drug use ( fast )
Colorado ( fast )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Bibliography:
Includes bibliographical references (leaves 152-1664.
General Note:
School of Public Affairs
Statement of Responsibility:
by Elizabeth Ann Moore.

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University of Colorado Denver
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Auraria Library
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62866004 ( OCLC )
ocm62866004
Classification:
LD1193.P86 2004d M66 ( lcc )

Full Text
, i A /
t/ri '
IDENTIFYING TANF RECIPIENTS SUBSTANCE ABUSE PROBLEMS IN
FOUR COLORADO COUNTIES
by
Elizabeth Ann Moore
B. A., University of Mississippi, 1988
M.S.W., University of Denver, 1992
A thesis submitted to the
University of Colorado at Denver
in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
Public Affairs
2004


2004 by Elizabeth Ann Moore
All rights reserved.


This thesis for the Doctor of Philosophy
degree by
Elizabeth Ann Moore
has been approved
by
Tom Brewster
Date


Moore, Elizabeth Ann (Ph.D. Public Affairs)
Identifying TANF Recipients Substance Abuse Problems In Four Colorado Counties
Thesis directed by Professor Peter deLeon
ABSTRACT
This dissertation examines the current state of welfare reform as it applies to
one population of welfare recipients that has proven particularly difficult to identify,
female substance abusing welfare recipients. This thesis addresses the problem of
accurately identifying female substance abusing welfare recipients from both a
theoretical and clinical/practical viewpoint. From a theoretical perspective, we
consider the transformation of welfare from an institution that assisted the needy
population with a financial hand out and limited ameliorative services, to an
organization where the needy population gets a hand up. The heeds of this
population cannot solely be met by Human Services. Hence, policies for contracting
with agencies to provide specific services will serve to address the multitude of
problems faced by this population. Further, for these policies to be effective, the
human service agencies themselves must be committed to the identification and
treatment of this population.
IV


Social Construction Theory and New Public Management are used to
explain this transformation using case studies through the lenses of grounded theory.
From a clinical perspective, this dissertation examines what approaches to drug and
alcohol identification were being utilized by Colorado County Department of Human
Services, which counties were making more attempts to identify substance abusers,
and the limitations of these county agencies approaches to identification.
The overall findings suggest that the theoretical frameworks had many
elements that were relevant to the analysis and interpretation. It was clear that
counties and even individual case workers were more likely to identify substance
abusing TANF recipients if their approach was to discuss openly the issue, attempt to
identify in multiple ways, and approach TANF recipients in a supportive and
accepting manner. Counties also were better able to serve their TANF population
when they had strong partnerships with other relevant agencies in their community
In conclusion, this dissertation accepts the propositions that substance-
abusing TANF recipients can be better identified despite barriers to this identification.
Further, to assist in this identification policy makers can create policies and
procedures that assist in better identification. However, these policies have to create
mechanisms for organizational culture change.
v


This abstract represent the content of the candidates thesis. I recommend its
publication.
Signed
Peter deLeon


DEDICATION
This dissertation is dedicated to my daughter Sarah, who patiently sat in the student
lounge while I attended and taught classes. This dissertation is also dedicated to my
parents, C. B. and Patricia Waldo for their ongoing support and encouragement of my
efforts.


ACKNOWLEDGMENTS
I would like to thank all members of my dissertation committee for their patience and
support of my work. To Peter deLeon, I cannot thank you enough for your guidance,
patience, and commitment to my learning and work. To Mary Nakashian, I greatly
appreciate your willingness to take the time to guide and assist me during this
process. I also would like to express my gratitude to Christi Jackson for her time and
energy in helping me grapple with my data analysis. Both Tamara Smith and Denise
Fichter are to be acknowledged for their assistance in adjusting my schedule to
accommodate interviews and for their assistance in my formatting challenges. Finally,
I thank all of the Adams County, Arapahoe County, Denver County, and El Paso
County Administrators, Case Workers, and TANF Recipients who were gracious
enough to take the time to complete my interviews. I appreciate their openness and
thoughtful responses; without them this work would have not been possible.


CONTENTS
Abstract.................................................... iv
Preface.....................................................xiii
CHAPTER
1. INTRODUCTION...................................................1
Problem Statement and Rationale: Substance Abuse Among TANF Women ..7
Thesis Organization...........................................18
2. WELFARE AND SUBSTANCE ABUSE LITERATURE REVIEW................19
Introduction................................................. 19
Welfare Reform Literature.....................................20
Substance Abuse Literature....................................26
3. THEORETICAL FRAMEWORKS.......................................34
Introduction..................................................34
Social Construction Theory....................................36
New Public Management (NPM)...................................44
4. METHODOLOGY................................................. 56
Introduction..................................................56
Design........................................................60
Research Guidelines...........................................67
IX


Sampling...............................................................70
Observation Methods................................................... 75
Validity, Reliability, and Limitations.................................83
5. ANALYSIS...............................................................89
Introduction.......................................................... 89
Case Study Analysis of Four Colorado Counties..........................94
Welfare Reform.........................................................97
Staff Educational Background..........................................100
External Contracting..................................................101
Substance Abuse Policies by Administrators and Case Workers...........102
Efforts to Identify Substance Abuse ..................................104
Substance Abuse Training by Administrators and Case Workers...........105
Assessment Documents..................................................106
Qualitative Comparative Analysis of TANF Recipients...................107
Limitations of the Data...............................................112
6. CONCLUSION............................................................115
Introduction..........................................................115
Proposition: Better Identification....................................117
Proposition: Facilitators and Barriers................................124
Proposition: Improved Policies........................................129
x


Unexpected Findings.........................................135
Policy Implications.........................................139
Implications for Future Research............................145
Limitations.................................................147
Conclusion..................................................148
APPENDIX
A. TANF Recipient Demographic Information...................151
BIBLIOGRAPHY.......................................................152
xi


TABLES
4.1 Interview Structure for Elite Personnel...............................77
4.2 Interview Structure for TANF Staff....................................79
4.3 Interview Structure for TANF Recipients...............................82
4.4 Strengths and Weaknesses of Data Collection Methods...................87
Xll


PREFACE
I have approached this study with an intimate relationship with the topic. I have
worked in the field of substance abuse treatment for twelve years. I am a Licensed
Clinical Social Worker and a Certified Addictions Counselor. I have worked directly
with TANF women in treatment and with their case workers. I have directed
programs for women and their children in residential treatment. Additionally, I have
co-authored a Technical Assistance Protocol for the Center for Substance Abuse
Treatment regarding the identification of substance abusing TANF recipients.
Currently, I am the Chief Operating Officer for Colorados largest provider of
substance abuse and mental health treatment, Arapahoe House, Inc.
xm


CHAPTER ONE
INTRODUCTION
The Personal Responsibility and Work Opportunity Reconciliation Act of
1996 (PRWORA) represents the most profound change to the nations welfare system
since it was fundamentally established as part of the New Deal in the 1930s.
PRWORA is a sweeping piece of legislation that affects many Human Service
Departments policies in addition to the provision of basic public assistance benefits
and substance abuse treatment. The final rule implementing Temporary Assistance
for Needy Families (TANF, the successor program to Aid Families with Dependent
Children, or AFDC) went into effect as of October 1,1999. The central mission of
PWORA is for welfare agencies to assist families in achieving self-sufficiency in a
timely manner. That is, welfare agencies have to remove barriers of the welfare
recipients so that they may obtain sufficient employment to sustain them and their
family without government assistance, hence self-sufficiency.
PRWORA creates significant new opportunities for states to help welfare
recipients become self-sufficient and improve their lives through work and work-
related activities. It also poses new challenges for states, for it insists that they assume
1


the primary responsibility for designing and implementing these changes. In the realm
of opportunities, states have been given wide flexibility to design programs that meet
the needs of their residents without excessive regulation by the national government.
They have been granted broad new authority to make and execute policies, allocate
funding, and re-organize agencies in the way they determine most appropriate. This
is, at least partially, a reflection of the New Public Management decentralization
approach being utilized with welfare reform in an effort to produce a more efficient
and effective welfare system (Hercik, 1998). Moreover, states have been appropriated
significant new funds to provide an extensive array of services to support welfare
recipients on their path to work and self-sufficiency, including day care and substance
abuse services.
Juxtaposing these responsibilities and opportunities, however, is a daunting
set of new challenges for individual states. Prior to PRWORA, it was convenient and
often logical for states to exempt the most troubled families from many program
requirements, and pay special attention instead to those who were closest to job
readiness (i.e., those prepared to leave welfare). This practice of welfare left those
most in need of welfare services on indefinitely without truly addressing their
particular needs. In many aspects, therefore, state officials had a very incomplete
picture of the needs, problems, strengths, and resources of the people receiving
assistance. However, faced with PRWORAs rigorous work rules and especially new
time limits for receipt of assistance, state welfare administrators must now better
2


understand the composition and special needs of their welfare caseloads. In particular,
they need to grapple with understanding the particularly complex and confounding
conditions engendered by substance abuse, which could prevent some families from
finding or retaining work.
Although any single or married parent could meet the criteria for welfare, the
welfare rolls are overwhelmingly single females. Therefore, when considering the
role of substance abuse in these recipients, one is basically examining effects of
substance abuse among female welfare recipients. In particular, a six-year
longitudinal study of welfare recipients found that only 30% of welfare recipients
who had substance abuse problems left welfare for employment compared to 52% of
non-substance abusing recipients (Schmidt, Weisner, and Wiley, 1998). Clearly, it is
necessary for TANF recipients for whom substance abuse is a barrier to work and
self-sufficiency to be identified so they can receive focused assistance in removing
that barrier.
It is critical that state welfare administrators understand the composition and
special needs of their welfare caseloads to develop policies and practices that
effectively assist their states welfare recipients. If welfare policies and their
implementation are found to be ineffective, the welfare recipients will greatly
straggle, especially as they will have their assistance cut off while still unable to
maintain work and self-sufficiency. It is easy to speculate that removing this
population from the welfare system could encourage them to move into criminal
3


behavior as they struggle to cope on their own. This speculation is evidenced by the
fastest growing prison population being predominantly women with substance abuse
and other mental health issues (Bloom, Lind, & Owen, 1994).
The New Public Management (NPM) orientation towards welfare
decentralization has resulted in each state and, in some states, each county, being
authorized to function in dramatically different fashions. The federal government
recognizes that for each state to function effectively, it must utilize its own creativity
and operate within its special context in training and motivating welfare workers.
Therefore, each state is charged with the responsibility of deciding how best to
administer welfare reform. Subsequently, not only could each state administer
different approaches to welfare reform and substance abuse identification, but each
state could also realize different results. For instance, the percentage of substance-
abusing TANF recipients identified, out of the total number of TANF recipients,
varies from state to state as well as from county to county within states. A
comparative study of states is beyond the scope of this research project; therefore, this
dissertation will instead be a comparative study of four of the counties in the State of
Colorado. Thus, the research question for this thesis is whether the approach taken by
various Colorado counties, in their effort to identify substance-abusing TANF
recipients, affects the effectiveness of identifying substance abuse among TANF
recipients.
4


The initial recipients of public assistance under Welfare Reform have reached
the end of their time-limited assistance (Hagen, 1999; Nakashian & Moore, 2000).
Therefore, a comparative examination of what has been tried, both successfully and
otherwise, is warranted. Not only would this information fill a current void in the
literature, but it also provides much needed practical guidance. Additionally,
examining alcohol and drug abuse identification efforts used by counties for efficacy
provides a contribution to the current and future attempts at policy implementation.
Since each county in Colorado determines its TANF policies and procedures with
respect to identifying substance abuse and other barriers to self-sufficiency (Berkeley
Policy Associates, 2001), one countys success could serve to inform other counties.
An examination of the difficulties within one area of the PRWORA (Welfare
Reform) illustrates the challenges faced when attempting to find alternatives to the
traditional liberal welfare practices. The current literature on Welfare Reform is
tremendous in terms of sheer volume. Much has been written on the general
implications of the shift in how the business of social services is conducted
(Danzinger, S. & Gottschalk, P. 1995). Yet, much of writings in this area is primarily
anecdotal with some examples of success stories related to the implementation of
welfare reform. Additionally, there is significant material related to various job skills
programs (Anderson, 1998). More recently, states are putting forth various reports
and analyses of their TANF programs.
5


The literature, however, clearly has some gaps that need to be addressed.
There are little, if any, significant comparative studies between states of what is and is
not successful from a programmatic viewpoint. Colorado produces an annual
evaluation reviewing a number of statistics related to the Colorado TANF roles. The
report reviews a number of aspects, such as length of time on TANF, number of
children in the household, age of adult, likelihood of getting off TANF based on
length of time on TANF, and several other similar statistics. This report also
examines the numbers of TANF recipients with developmental disabilities and mental
illness. While the narrative portion of the report lists substance abuse as a barrier to
employment, there is no attempt to evaluate what those numbers represent in terms of
a break down of the number with substance abuse as a barrier (Berkeley Policy
Associates, 1999,2000,2001). Similarly, on a national level, welfare recipients with
alcohol, drug, and other mental health problems have been identified as difficult to
manage (Coico, 1998); however, clear recommendations on how to serve this
population better are scarce. Therefore, the area to be examined in this dissertation is
the identification of substance abusing welfare recipients. That is, are there
identification policies, procedures, and techniques that lead to more accurate
identification of substance abusing TANF recipients?
6


Problem Statement and Rationale:
Substance Abuse Among TANF Women
Unlike the previous welfare program, the overwhelming focus of TANF is to
move recipients from system dependency to self-sufficiency. Many barriers have
been identified that can impede progress in moving a family from welfare to self-
sufficiency, and one of these is the use and abuse of alcohol and other drugs. Over
95% of these family groups are headed by a single female parent, who has special
needs and requirements in order to receive appropriate intervention and treatment
services (Grella, Polinsky, Hser, and Perry, 1998). As substance abuse is a significant
barrier to employment retention, it is necessary for welfare offices to specifically
identify and address it amongst welfare recipients. However, substance-abuse is not a
barrier a TANF recipient would easily disclose. Therefore, the research question here
is are there ways for TANF workers to accurately identify substance-abusing TANF
recipients.
To avoid any confusion of terms, it is useful to define what is meant by
substance abuse. In the United States, the use of certain substances to modify mood
or behavior under certain circumstances is generally regarded as acceptable and
normal. For example, the recreational use of alcohol or the use of caffeine is not
viewed as unacceptable behavior. However, due to the wide cultural diversity in the
American society, there are certainly cultural variations as to what is acceptable. In
7


groups, the use of various illegal substances for mood-altering effects has become
widely accepted (i.e., although usually illegal, marijuana). In addition, certain
psychoactive substances are used medically for the alleviation of pain, relief of
tension, or to suppress appetite, but certainly can be used and abused illicitly (DSM-
IV, 1992).
When considering substance abuse diagnostically, the focus is examining
symptoms and maladaptive behavioral changes associated with more or less regular
use of psychoactive substances that affect the central nervous system (i.e., cocaine,
heroin, methamphetamine). The maladaptive behaviors considered are ones that
would be considered undesirable in almost all cultures. Examples include continued
use of the psycho active substance despite the presence of a persistent or recurrent
social, occupational, psychological, or physical problem that the person knows may
be exacerbated by that use and the development of serious withdrawal symptoms
following cessation of or reduction in use of a psychoactive substance (DSM-IV,
1992). Although TANF caseworkers are not expected to diagnose TANF recipients
with substance abuse or substance dependence, they should be concerned with the
TANF recipients who are abusing these substances to the point that these substances
interfere with their ability to parent, maintain employment, and function reasonably in
their social roles.
The Diagnostic Statistical Manual-IV (DSM-IV) recognizes that substance
abuse can interfere with employability and has therefore listed work-related problems
8


as a symptom of substance abuse and dependence. It is clear not only diagnostically,
but also practically that there is a correlation between substance abuse and
employment problems. A large study conducted by Health and Human Services
Substance Abuse and Mental Health Services Administration found that workers who
reported current illicit drug use were more likely than those who did not to have
worked for three or more employers (9% vs. 4%) and voluntarily left an employer in
the past year (25% vs. 15%) and to have skipped one or more days of work in the past
month (SAMSHA, 1999). While recipients may obtain a job for a short period of
time, they are likely to fail at the job over time unless their problems with alcohol or
other drugs are addressed (Lindbeck, 1997). In Colorado, workers who reported
current illicit drug use compared to those who did not report current drug use were:
more likely to have worked for three or more employers (95% vs. 4%) in a year; and
more likely to have left employment voluntarily (25% vs. 15%) in a year; and more
likely to have missed one or more days of work (13% vs. 5%) in a month (Colorado
Substance Abuse Group, 2004).
Numerous studies have concluded that substance use and dependence are
more common among female TANF recipients than among females not receiving
TANF. Illicit substance use is associated with welfare even after controlling for other
factors such as race, education, and region (Nakashian, 2002). A 1998 NHSDA
analysis reported that 21% of TANF recipients had used an illicit substance within
the last year, compared to 12% of those not receiving TANF. This same analysis
9


found that illicit drug dependence was about twice as common among TANF
recipients than those not receiving TANF (Pollack, et al. 1999).
Various states have conducted their own analyses and the range of substance
abuse prevalence among TANF recipients is between 12% and 20%. When TANF
recipients are broken in to specific sub-groups, these rates increase dramatically. A
study of sanctioned TANF recipients in New Jersey found 49% of sanctioned
recipients had substance abuse problems ('www.mha.state.mi.us/drug testing, 2002).
Sanctioning is the consequence administered to TANF recipients when they do not
comply with their case plans, which are called Individual Responsibility Plans.
Sanctioning means that they begin to lose their benefits.
Although state TANF agencies are largely attuned to the need to address
substance abuse among their caseload, effectively doing so has been elusive for
many. Some of the more progressive agencies have been implementing training of
staff on alcohol and drug issues, hiring alcohol and drug specialists on-site, using a
variety of screening instruments, and interviewing techniques as a means to identify
more accurately possible substance abusers (Weaver and Hasenfeld, 1997).
Michigan attempted to implement mandatory drug testing via urinalysis for
eligible recipients applying for TANF, but it is currently not in effect due to a class
action lawsuit, despite federal PRWORA guidelines listing it as an acceptable
practice. Some even more innovative approaches from different states include special
outreach efforts such as home visits, the use of recovering staff to address alcohol and
10


drug abuse needs of recipients, and implementation of social marketing strategies,
such as displaying pamphlets and other written materials to address the alcohol and
drug needs of TANF applicants and recipients. These innovative practices are being
implemented in an effort to accurately identify substance abusing TANF recipients.
States and TANF workers typically base their substance abuse identification
expectations on their knowledge of the prevalence of the problem in the population.
Nationwide, identification and referral for substance abuse services among TANF
recipients are much lower than would be expected, given the prevalence of the
problem in the general population. Researchers who have analyzed secondary data
collected prior to the passage of PRWORA vary in their estimates of recipients
engaged in substance abuse, ranging from 6 percent to 37 percent (Olson and Pavetti,
1996). Pollack & Jayakody (1999) conducted a pre-welfare reform benchmark study
that provided information about families who received welfare prior to PRWORA.
Their research found that:
Most women who ever received AFDC payments did not exceed two years.
Thirty-eight percent of mothers who ever received AFDC exceeded five years.
Long-term (more than five years) AFDC recipients were more likely to be
never-married teen mothers, and were significantly depressed. These
recipients were more likely to have lower levels of education, as well as lower
levels of social and job skills.
11


Substance abuse was significantly higher among long-term recipients than
among short-term recipients.
Heavy drinking, smoking, and marijuana use were significant predictors of
entry into the welfare system.
Substance abuse among TANF recipients is also highly associated with mental
illness and domestic violence (Nakashian, 2002). A Utah study of TANF recipients
found that 42 percent were clinically depressed, 7 percent had generalized anxiety
disorders, 12 percent were domestic violence survivors within the past year, 23
percent had learning disabilities, 35 percent had medical problems that prevented
them from working, 30 percent had poor work histories, and 23 percent had children
with sever behavior problems. Ninety-two percent of TANF families face one of
these problems, 26 percent faced three of them, and 37 percent faced four or more of
these problems (Barusch, et al., 1999).
Several studies have been conducted to determine the prevalence of substance
abuse among welfare recipients since PRWORA was passed. Estimates vary, at least
partially as a function of how these estimates were obtained. Green, et al. (2000)
interviewed 512 adult TANF recipients in California about barriers to work. Green
found that, depending on whether substance abuse was defined narrowly or broadly,
between 10 percent and 22 percent of TANF recipients had substance abuse problems
that posed barriers to work. A survey of 740 women in Floridas TANF program
indicated that 12 percent had consumed alcohol to intoxication within the past 30
12


days and 5 percent reported using an illicit drug in the last month (Merrill & Ring-
Kurts, 1999). In Michigan, face-to-face interviews with 753 single TANF women
estimated that 2.7 percent were alcohol dependent and 3.3 percent were drug
dependent. More recently, results from urine tests required of Michigan TANF
applicants, indicated that 10 percent of tests were positive for drug use (Danziger et
al., 1998: Michigan Family Independence Agency, 1999).
The New Jersey Department of Health and Senior Services conducted a study
(Kline, Bruzios, Rodriguez, & Mammo, 1998) of characteristics of the states TANF
population. Welfare workers in New Jersey are required to administer the CAGE (a
short written questionnaire) to all TANF recipients. Only 1 percent of the recipients
screened positive for drug use, based on the CAGE questionnaire. The state also
conducted a research study in which researchers interviewed a representative sample
of approximately 1300 TANF recipients and administered a diagnostic assessment
measure to determine substance use diagnoses. The researchers then analyzed hair
samples from 384 of those who responded to the diagnostic assessment measure. The
hair analyses indicated that 27 percent of those tested were positive for some illicit
drug use, mostly cocaine, and about 11 percent were positive for heavy use of at least
one drug. Kline, et al. (1998) found a large discrepancy between the hair analyses and
self-reports of substance use problems in response to the diagnostic assessment. For
example, more than 25 percent of respondents tested positive for the use of cocaine
based on the hair analysis, but only 12 percent self- reported using cocaine in the six
13


months prior to the test. The researchers combined data from the self-reports on the
diagnostic assessment with data from the hair analysis, and arrived at a figure of
about 20 percent of the sample that needed substance abuse treatment.
In general, recipients self-reported responses to questions included as part of
PRWORA welfare applications suggest substance abuse problems in the range of 1
percent to 3 percent (Morgenstem, 1999). This is far lower than even the most
conservative research findings. Administrators (GASA, 1999) and welfare recipients
themselves (Focus Group, The Haven, 1999; Focus Group, Women in Need, 2000)
report that the problem is higher than state experiences suggest, although information
from these sources is based on responses to questions and not on standard scientific
research.
A few states, however, stand out as having had some success in identifying
TANF recipients with substance abuse problems. Oregon started integrating
substance abuse treatment into its welfare program in 1992, well before the passage
of PRWORA (Kirby, Pavetti, Kauf & Tapogna, 1999; Pavetti & Paulos, 1997).
Oregon has identified 19 percent of its welfare recipients as having substance abuse
problems (Morgenstem, 1999). North Carolina has attained identification rates of
about 23 percent when qualified substance abuse professionals conduct screenings for
substance use, and about 11 percent when welfare staff conducts these screenings
(Legal Action Center, 1995).
14


There are many possible reasons for the apparent discrepancy between results
based on self-reports to welfare workers, self-reports to researchers, and results from
drug tests. It does appear, however, that when welfare applicants or recipients are
asked about their substance use, compared to when their urine or hair is tested, there
are lower rates of reporting substance use. This is understandable given that in
revealing their substance abuse, they risk being sanctioned up to the point of losing
their benefits. If welfare recipients believe that they will possibly be penalized versus
receiving help for admission of substance abuse issues, it is unlikely that they will
self-report accurately. This belief stems not only from how sanctions are written into
policies, but also from how they are implemented, that is, the attitude of TANF case
workers towards substance abusing TANF recipients.
The National Center on Addiction and Substance Abuse at Columbia
University (CASA) and the American Public Human Services Association (APHSA)
surveyed administrators of welfare, employment, and substance abuse treatment in all
50 states. About half of state TANF administrators responded that at least 20 percent
of TANF recipients had substance abuse problems that needed to be addressed in
order for them to retain employment. Administrators ranked substance use as third
out of seven challenges to meeting work requirements, with 14 indicating that they
had mechanisms in place to estimate the proportion of TANF recipients with
substance abuse (CASA, 1999).
15


In Colorado, the Alcohol and Drug Abuse Division (AD AD) of the
Department of Public Health and Environment (2001) conducted a telephone survey.
The survey included questions about alcohol, marijuana, cocaine, hallucinogens,
stimulants, sedatives, inhalants, heroin, and other opiates. Sixty-nine percent (2,311)
of randomly selected Medicaid recipients were surveyed. Females represented ninety
percent of the survey population. The respondents were representative of the TANF
population. Of those surveyed, 40 percent reported using alcohol only in their
lifetime, while 52 percent reported using both alcohol and drugs at some point in their
life. Eight percent reported never using alcohol or drugs. When use was limited to the
past year, it decreased with 42 percent reporting no use, 47 percent alcohol only, 2
percent drugs only, and 9 percent alcohol and drugs.
This same study resulted in other interesting information regarding TANF
recipients. Using the DSM-IV criteria, 14 percent of the respondents were identified
as having substance abuse or dependence at some point in their lifetime with 6
percent identifying an abuse or dependence problem in the last year. Of the women
with an abuse or dependence problem in the last year, 47 percent had also been
pregnant during that time. Of those who had been pregnant, only 25 percent had
received substance abuse treatment. Of all of those with an abuse or dependence
problem in the past year, 83 percent had been responsible for children during the
same period and only 25 percent had received substance abuse treatment.
16


All of these findings suggest that there is a significant problem with under-
identification of substance abusing welfare recipients. The findings from Oregon and
North Carolina offer hope that despite the problem, subsequent policies and
procedures can be implemented that help successfully identify substance abusing
welfare recipients.
It appears, therefore, that substance abuse among recipients might well be a
marker or predictor for long-term dependency on welfare and for the presence of
related problems such as depression. Given PRWORAs five- year limits for welfare
eligibility, this presents a significant and immediate policy issue. If the current
welfare policy remains in place, it is likely that those substance abusing welfare
recipients presently not identified will be removed from the welfare rolls and will not
be self-sufficient. Their futures will surely become worrisome from both a personal
and social perspective. Many will find themselves homeless, victimized, and/or
involved in the criminal justice system. Essentially, failure to identify adequately and
treat these individuals means that policy makers will be forced to continue to try and
manage this population not only in the human services systems, but also in the much
less humane mental health and criminal justice systems. These will surely entail
greater cots than presently incurred.
17


Thesis Organization
In addition to the introduction, this thesis, in Chapter II offers two literature
reviews, Welfare Reform and Substance Abuse. This is followed in Chapter III by a
review of two theoretical frameworks, Social Construction Theory and New Public
Management. The theoretical frameworks and the review of the relevant literature
provide preliminary guidance to the study. Following the literature review and
framework discussion is Chapter IV, Methodology, which articulates the data
collection and analysis. This thesis is concluded with an Analysis Chapter V, and
Findings Chapter VI, which reflect the conclusions, necessary reservations, policy
implications, as well as the possible future research.
18


CHAPTER TWO
WELFARE AND SUBSTANCE ABUSE
LITERATURE REVIEW
Introduction
To address this research problem appropriately, it is necessary to examine two
bodies of literature. At times they may seem to overlap, but are largely separate. The
first area to consider is the literature on welfare reform. Second, it is necessary to
examine the literature related to the efficacy of alcohol and drug abuse identification
and treatment.
The literature review on welfare reform will cover welfare reform from a
national and state level. Welfare reform provides states great freedom to administer
welfare, which will be discussed further in this chapter. One of the many options is
for each state to determine if they want welfare to be administered at a state level or
at a county level. In Colorado, welfare is administered at a county level. Therefore,
the welfare literature specific to Colorado will be explored, as well as welfare
literature on a national level.
The substance abuse literature is extensive. For the purpose of this
dissertation, only two aspects of this body of literature are relevant for consideration:
substance abuse assessment instruments, and the effect of treatment on work
19


substance abuse assessment instruments, and the effect of treatment on work
outcomes. Although this thesis does not examine the relative efficacy of different
treatments modalities, by touting the importance of identifying substance-abusing
TANF recipients so that they can receive treatment, the presumption is that treatment
is or can be effective. For this reason, it is necessary to review the literature on the
effectiveness of treatment.
Welfare Reform Literature
The literature related to welfare reform is extensive and growing. It has
clearly received significant attention both in the academy and in the public. Given the
various arenas that have an interest in welfare reform, there is a broad range in the
quality of the stories. There is informal work, such as Hillary Clinton (1999), who
wrote for a White House publication, about some of the pitfalls of the structure of
welfare benefits as illustrated through one womans story. Lay periodicals, such as
Time (1999) and The New York Times (1999), provide multiple articles that illustrate
successes and failures for both individuals and groups. On the other end of the
spectrum, there are numerous academic studies, such as Stephanie Schaefers (1999)
case study of policy formation in Illinois. Sheldon Danziger has examined general
barriers to employment for welfare recipients (1998), as well as how economic
conditions affect employment (1999). Others such as Gardner, Young, and Merrill
20


(2000) have looked more specifically at the group of welfare recipients who are not
obtaining self-sufficiency.
The struggle with poverty and welfare in the United States is long standing
and PRWORA does not represent the first attempt at getting welfare recipients to
work (Patterson, 1981). Shortly after the creation of the New Deals Federal
Emergency Relief Administration (FERA), it was recognized that it was demoralizing
to most people to receive a hand out, and they needed help with employability. It
also became clear that some people had significant barriers to employability
(Patterson, 1981). Hence, they were left with the same challenges we face today.
More recently, welfare reform has been widely studied and evaluated,
particularly in the area of moving clients to self-sufficiency through employment
stability (Rom, 1999). Weinstein (1999) and Lindbeck (1997) have addressed the
complexities of the relationship between employment and welfare reform mandates.
The Manpower Demonstration Research Corporation (MDRC) has conducted several
national evaluations of welfare-to-work programs, and is now directing studies of
programs designed under the TANF rules. In particular, MDRC directed a Project on
Devolution and Urban Change, examining how welfare agencies, poor
neighborhoods, and low-income families in four large cities are affected by welfare
reform (Quint, et al., 1999). There have also been studies about the effectiveness of
job skills programs for low-income people, which indicate that when they have few
other obstacles to employment, they generally respond well to training and find
21


suitable employment (Anderson, 1998; Weinstein, 1999; Lindbeck, 1997; MDRC,
1997).
The next most frequently discussed area, which dovetails closely with the area
of job training and is closely aligned with PWRORA legislation, is who will remain
on welfare. This continues to be an area that is addressed more as the first wave of
TANF recipients has ended their time limit for receiving assistance. Given that the
mandate of welfare is now defined such that a person only receives assistance long
enough to obtain suitable employment and become self-sufficient, those who are not
achieving that goal need to be examined. Sheldon Danziger (1998) explored this issue
from a policy implementation perspective, and discussed the limitations of current
requirements. Danziger addressed how current requirements and time limits could
result in those who do not obtain self-sufficiency finding them involved in other
systems, such as the criminal justice system. Others, such as Sonya Kessinger (1998),
carefully examine some of the possible variablese.g., substance abuse, mental
health issues and physical disability limitations; which may contribute to someone
remaining on welfare. Clearly, the consensus is that those who have few barriers to
employability move quickly off the welfare roles with some job readiness training.
However, those with multiple barriers to employment and self-sufficiency are likely
to remain longer, possibly exhausting their benefits.
The areas of state evaluations and policy theory and options are critical
areas in welfare reform, and are increasingly being viewed as practical enough to
22


warrant significant attention, as states are now collecting data relating to the
outcomes as they pertain to PRWORA legislation. Gordon, Jacobson, and Fraker
(1997) offer a comprehensive look at how states designed their federally mandated
state program evaluations. They discuss the limitations of the primarily ad hoc
experimental evaluation designs and argue for the less utilized, but more expensive
quasi-experimental designs. Interestingly, Wisconsin, generally considered one of the
leaders in welfare reform, was the only state that has used a quasi-experimental
design and is also a state that has been considered quite successful in its approach to
welfare reform in general. While this may imply that a quasi-experimental design
could better inform policy, the reality is that most human service departments do not
have enough resources for the services needed leaving little for evaluation.
Similar to many states, Colorado annually examines a variety of factors
statewide related to who leaves TANF and who remains. Colorado tracks such items
as re-entry rates, re-entry characteristics (however, not characteristics such as mental
illness or substance abuse), probability of exit from Colorado Works after various
periods of time, and long-term and short-term caseloads. The Colorado report found
two factors positively related to the likelihood that a person would leave the Colorado
Works program and be employed. These factors are age specifically, 36.5 years old or
younger and the number of quarters employed before entering the program. In
essence, if readily employable, she will realize success in the Colorado Works
program. The factors negatively related to the likelihood that a person would leave
23


the Colorado Works program and be employed are age (36.6 years of age or older),
and number of children, total number of months on assistance, unemployment rate,
medical needs, homelessness, mental health needs, domestic violence, referral to SSI,
lack of child care, referral to vocational rehabilitation (Berkeley Policy Associates,
2001). In addition to state reports, there is an increase in publications offering policy
options and promising practices (Legal Action Center, 2001; CSAT, 2002).
Specific theories on what TANF policies and procedures should be seem to
appear more indirectly in the literature. It is found, for example, in graduate theses
(Hirsch, 1999) or is briefly mentioned in the context of something else in various
articles (Brodkin, 1997). Some authors, such as Mark Rom (1999) and Robert Cox
(1999), however, provide more extensive discussions in this area particularly as it
applies to implementation. Although there have been studies about changing
organizational cultures, particularly government cultures (Osborne and Plastrik, 1997;
Ban, 1995; Howard, 1995; Ingraham and Romzek & Associates, 1994; Osborne and
Gaebler, 1993), specific research in the field of welfare culture change is scarce
(Hercik, 1998), although this is an area of increasing interest to policy makers
(Meyers, et al., 1998). While welfare culture change research is scarce, there is
increasingly more anecdotal reporting. Various states who are having some success
have presented these case studies in various reports (Legal Action Center, 2002).
Welfare policies are now requiring closer examination as welfare reform has
changed the way our society views poverty and dependence. There are numerous
24


opportunities for families in need of self sufficiency and the agencies that can guide
and support them. State and county governments have the opportunity to set policies
that offer the opportunity to address long standing problems. They have flexibility to
use their dollars in the most effective manner for their welfare population including
substance abuse treatment (Nakashian, 2002). Welfare reform offers states a variety
of policy options, such as:
Opting out of or narrowing the ban on TANF and food stamps for individuals
with drug felony convictions.
Adopting a narrow definition of medical services to avoid unnecessary
restrictions on the types of treatment services TANF can fund.
Not terminating Medicaid benefits for TANF recipients who are willing to
enter treatment or who are complying with treatment requirements.
Co-locating alcohol and drug treatment professionals in TANF offices to
screen recipients for alcohol and drug problems and refer them to treatment,
when appropriate.
Investing TANF funds in a range of appropriate treatment services, including
outpatient and residential services that are non-medical (Legal Action Center,
2002).
25


Substance Abuse Literature
The second body of literature reviewed for this chapter is substance abuse
with particular attention to drug and alcohol assessment techniques and the impact of
treatment on employment. The literature on drug and alcohol abuse, in general, can be
divided into two predominant categories, assessment and treatment. These two areas
frequently overlap as the goal of drug and alcohol assessment is to assess accurately
and refer clients to the appropriate level of treatment. As the full extent of this
literature is not relevant to this thesis, this review focuses on assessment tools and
techniques and the effect of treatment on employment outcomes.
The literature on substance abuse assessment instruments for individuals is
readily subdivided in two different modes. First, it can be divided by length of time
required to complete assessment instruments, short or long: short assessments are
those that can be completed in about ten minutes, and long assessments are those
requiring one to two hours to complete. Second, articles that simply discuss the
strengths and limitations of one particular instrument and articles that compare the
efficacy of multiple instruments. The number of assessment instruments available is
inordinate. Bradley, et al. (1998) discuss the most commonly used, e.g. AUDIT,
CAGE, DAST 10, MAST, and SASSI.
The Alcohol Use Disorders Identification Test (AUDIT) is designed to
identify people whose alcohol use has become a danger to their health. It includes
three subscales that assess the amount and frequency of drinking, alcohol dependence
26


and problems caused by alcohol. It has ten questions that can be self-administered or
asked by another person and takes about one minute to complete (Babor, T., de la
Fuente, Saunders, J. & Grant, M., 1992). The CAGE (an acronym for four questions)
consists of four questions that can be self-administered or asked by another person.
These questions can easily be built into other questionnaires (Mayfield, D., McLeod,
G. & Hall, P., 1974). The Drug Abuse Screening Test (DAST 10) is designed to
assess the use of illegal drugs in the twelve months preceding administration. It
consists of ten questions whose cumulative score indicates whether there is a drug
problem, whether monitoring the person is indicated, or whether further investigation
or assessment is needed (The Addiction Research Foundation, 1992).The Michigan
Alcoholism Screening Test (MAST) is designed to screen for lifetime alcoholism
problems. It consists of twenty-five questions that can be self-administered or asked
by another person and takes about five minutes to complete (Selzer, 1971). The
Substance Abuse Subtle Screening Inventory (SASSI) is designed to screen for
chemical dependency and is particularly resistant to efforts at faking and/or
concealing problems. It consists of seventy-eight questions and can be completed in
ten to fifteen minutes (Miller, 1985). The literature on the more lengthy instruments,
such as the Addiction Severity Index and the Composite International Diagnostic
Interview, is as prevalent as the literature on the shorter instruments.
All of the instruments are designed to try to identify substance abuse problems
in varying degrees. The questions are taken from the criteria found in the DSMIV.
27


The shorter instruments are limited in how many symptoms they can identify. What is
obtained from these instruments is not enough to make a diagnosis, but is enough to
determine if further assessment should be conducted. The longer instruments obtain
significantly more detailed information, often enough to make at least a preliminary
diagnostic determination.
The value of the shorter instruments is obviously the timeliness. As there are
multiple arenas such as probation offices, parole offices, schools, and mental health
clinics where substance abuse problems is not their focus, but something they may
want to screen for. These instruments require little training and can be added into
other assessment activities they may be conducting. The longer instruments require
more training and basic clinical skills, but do provide more specific information on a
persons substance use.
Ericson (2001) and McLlellan (1999) are representative examples of the
literature on some of the longer individual instruments. They offer multiple instances
where their instruments are tested for validity and reliability. The literature that
compares the relative efficacy of different longer instruments with each other is
significantly more limited. The longer instruments have been found to be highly
reliable and valid, but it is not clear if one is more effective than another due to the
lack of comparative studies with these instruments.
Svikis et al. (1996) provide comparative studies of the shorter instruments.
For the purpose of this study, the comparative studies related to the briefer
28


instruments is more useful as the anticipated recommendations could help Human
Services Departments form policy regarding how their TANF workers attempt to
identify substance-abusing TANF recipients. States that are currently using
instruments are using the shorter ones for two primary reasons. First, TANF workers
have limited time with clients and, therefore, cannot take the necessary time to
complete the longer instruments. Second, the shorter instruments require little training
or substance abuse knowledge on the part of the administrator in order to be
accurately administered, although, of course, their efficacy is more problematic.
It should be noted that the substance abuse literature focuses on assessment
instruments only. It does not address other techniques to assess individuals for
substance abuse severity such as home visits, red flag checklists, or urinalysis. With
some noted success, Oregon and North Carolina have implemented such techniques
as co-locating substance abuse counselors and case workers in the same building
(Legal Action Center, 2002). Additionally, the validity of these instruments has been
determined by their use in a treatment environment.
These aspects of the literature on testing procedures have significant
implications for welfare offices. Unlike a treatment environment, welfare offices are
dealing with a population that has not already disclosed substance use and has
multiple reasons to refrain from making such a disclosure. Therefore, an instrument
found to be equally reliable and valid in an environment where substance use has
already been disclosed would not necessarily be reliable and valid in an environment
29


where clients typically conceal disclosure of substance use. Welfare offices,
therefore, need to be able to administer paper and pencil instruments, but also some
other effective substance abuse identification techniques. Currently, there is no
literature to evaluate and guide the use of assessment instruments and other
identification techniques in welfare offices.
Another important aspect of substance abuse literature examined is the effect
of treatment on work outcomes as federal welfare reform places the highest priority
on moving recipients to work as quickly as possible. Many studies make it clear that
substance abuse is a barrier to work and that substance abuse treatment can improve
work-related outcomes. Substance abusers have been shown to be extremely costly to
employers (Banta and Tennant, 1989). Studies of the unemployed suggest that
substance use directly affects the duration of work, largely by producing an episodic
pattern of unemployment (Wiclrizer, 1997; Blum, 1995). A study conducted by the
Substance Abuse and Mental Health Services Administration (SAMHSA, 1999)
found that workers who reported heavy alcohol use were twice as likely as those who
did not report such use to have worked for three or more employers in the past year
and to have skipped one or more days of work in the past month.
Research findings regarding the effect of substance abuse treatment on
employment status of welfare recipients significantly and overwhelmingly suggests
that treatment works. Importantly, substance abusers who engage in treatment are
more likely to remain in stable employment than substance abusers that are not in
30


treatment. In the Center for Substance Abuse Treatments (CSAT) Integrating
Substance Abuse Treatment and Vocational Services, a variety of studies about the
connection between treatment and work are reviewed. In California and Missouri,
studies by Pavetti (1997), Young (1994), and Young and Gamer (1997) found
improvements in employment rates of as much as 60 percent among Californians who
received treatment, and 136 percent for people in Missouri who received treatment.
The National Treatment Improvement Evaluation Study (1997) examined
outcomes for 1,374 women in federally funded substance abuse treatment programs.
This study found that women in treatment reduced their drug use by more than 40
percent for as long as a year after treatment, and that 50 percent of the women who
received treatment reported employment one year after treatment.
More recently, there have been studies relating specifically to substance
abusing welfare recipients who received treatment. A Washington state study found
that treatment had a significant positive effect on employment (Wickizer, 1999).
Work outcomes were examined for welfare recipients in residential and methadone
treatment protocols, compared to a control comparison group of people who did not
receive treatment. Of those who received intensive residential treatment, 64 percent
more were employed than those in the comparison group. Of those who received
methadone maintenance, 50 percent more were employed than those in the
comparison group. This study also found that treatment resulted in reductions in
welfare. Other studies have concluded that substance abuse treatment saves public
31


funds. A study by Wickizer (1997) compared Medicaid and other welfare costs
incurred by people who had completed treatment to those who had not. The cost
incurred by those not completing treatment was notably higher.
What is clear is that treatment for substance abuse has been demonstrated to
be effective. It has been demonstrated to assist substance abusers in obtaining and
maintaining employment. With the assistance of treatment protocols, they begin to
live productive self-sufficient lives. Therefore, if the American society is going to be
successful in employing this group of substance abusers, it only stands to reason that
their success rates will gain significantly if they receive a treatment regimen. How
best to get this group into treatment is beyond the scope of this thesis. The focus here
is only on what is the most effective approach to accurately identify them. Currently,
this is a struggle as the only paper and pencil assessment instruments available are
those used in treatment environments where substance use has already been admitted.
Therefore, some states have begun to experiment with other innovative techniques for
identifying, but no consistent protocol has been established. If an effective protocol
could be established, there would be tremendous implications for future policy related
to this area.
In essence, it is clear that substance abuse is a barrier to employment, and the
goal of TANF is to move recipients into employment and self-sufficiency within a
prescribed time frame. Further, there are clear findings that substance abuse treatment
improves employment rates and retention for substance-abusing people. However, we
32


also know that substance-abusing TANF recipients, for a variety of reasons, are
reluctant to disclose substance use. Therefore, it is imperative that TANF workers
have the skills and tools necessary to identify substance-abusing TANF recipients.
While some states seem to be realizing some success in this area, their policies
and techniques are not rapidly replicated by other states. One can only speculate some
of the reasons this may be the case. Perhaps there are significant geographical and
cultural differences, or the complexities of the various state budgets and political
environments contribute to this.
In Colorado, the counties administer their TANF programs independently.
The Colorado Department of Human Services receives its Federal allocation for
TANF, which is then distributed to the counties, who then choose how to best
administer it within the Federal and State TANF guidelines. Therefore, the goal of
this dissertation is to determine what some of the various Colorado counties are doing
to better identify substance abusing TANF recipients. Further, a careful examination
of a country or counties that are having success in identification should result in the
ability to develop preliminary policy recommendations.
33


CHAPTER THREE
THEORETICAL FRAMEWORKS
Introduction
The two theoretical frameworks of most relevance for this dissertation are
Social Construction and New Public Management. The former is relevant as it
provides a framework from which we can conceptualize the evolution of welfare, as
well as the societal impact of welfare reform. New Public Management offers a
framework that assists in explaining the reason for welfare reform, as well as the
approaches taken to accomplish it. Jointly they compliment each other when
considering all elements involved in the ability to accurately identifying substance
abusing TANF recipients.
The relatively recent revision in welfare reform has led to the development of
a variety of theories related to the welfare system. The overwhelming limitation of
many of these theories is that they only address the recent developments in the
welfare system and ignore the previous phases (Cox, 1999). This limitation is
significant as the current state of welfare cannot be fully understood or interpreted
without an understanding of its historical development and significance. Social
construction theory has the ability to explain not only the current welfare state, but
34


directed towards them based on how they are socially constructed in the viewpoint of
society and policy makers.
In a time when policymakers are asked to provide solutions to complex social
problems, such as welfare reform, a predictable pattern is to follow scientific
methodologies that hinge on such hard factors as replicability and testable
hypotheses. However, as social problems have become increasingly complex and
seemingly intractable, policymakers find that these empirical or positivist
orientations may not provide the level of certainty and reliability relative to social
issues as neatly as they do matters of physics or biology (Schneider & Ingram, 1993;
Fischer, 2003). One alternative is to pursue a divergent course, and to seek out the
answers to social problems from society itself.
As the term Welfare Reform would suggest, the system of welfare has been
reformed in an attempt for efficiency, effectiveness, and improvement of the services
received by welfare recipients. Max Weber (1905) asserted that a bureaucratic
government was originally created as a movement towards efficiency, effectiveness
and protection of the rights of its citizens. The New Public Management movement is
an attempt to accomplish this in areas of government that have become broken.
New Public Management insists these goals can only be reached through a
government that is competitive, mission-driven, customer-driven, results oriented,
and decentralized (Osbourne & Gaebler, 1993; Lane, 2000; Atiyah, 1996).
35


Social Construction Theory
Social construction theories are unique in that some of the approaches
advocate a strict, objective method, whereas others follow a more discursive path.
The stricter approaches are derived from a more positivist perspective and lend
themselves more to quantitative study. The discursive paths are more qualitative in
nature and lend themselves to a grounded theory approach to research. This
dissertation suggests that contextual social construction can provide a valuable tool
for decision-makers in understanding the many ways that the social issue of welfare
reform is perceived by those that are affected by the policy outcome.
Social construction theory is largely borrowed from the social-psychology
field. Opposing the view that reality is an objective phenomenon (that is to say, fixed
and measurable), social construction theory holds that reality is actually the product
of individual, usually aggregated perceptions. These perceptions become shaped and
developed through interactions with other members of society. Reality, therefore, is
socially constructed by members of society, rather than existing as a fixed, objective
truth. Sociologist W.I. Thomas described constructionism in quite simple terms: If
men define situations as real, then they are real in their consequences (Ritzer, p.
121). This concept of definition, and specifically that different people may define
issues, objects, and phenomenon in vastly different ways, makes up the foundation of
social construction theory. One could reasonably argue that since the social
36


construction of things is so variable across populations, defining, let alone solving
social problems could prove challenging.
Theories of social construction developed originally in the social-psychology
field. Dominant in the 1920s and 1930s, the symbolic interactionism paradigm has
provided the theoretical foundation. Unlike the dominant paradigms of sociology,
symbolic interactionism draws largely on the tenets of psychology and focuses on the
individual as the unit of analysis, rather than organizations or social institutions.
Symbolic interactionism largely explains society in terms of the interactions among
individuals, and how those interactions contribute to the larger social structure and
culture. Social construction theory has evolved from this paradigm, continuing to
%
focus on individual relationships and how those dynamics contribute to the
construction (or creation) of a shared social reality.
Social Construction provides a framework for problems that are intertwined
with the human condition. Since the beginning of time, human societies have
constructed themselves so that they are composed of like-minded individuals, while
those outside of their society are somehow defined as different (Schneider & Ingram,
2003; Nicholoson-Crotty & Meier, 2003). For example, the United States was
founded on the principles of equality for all, but then proceeded to only give white
males the right to vote and endorsed slavery. Clearly, over time these things have
changed and other policies have been put in place to further the goal of equality (e.g.,
greater voter enfranchisement).
37


The very process of governance identifies and constructs groups as deserving
and undeserving. This ordering inevitably creates societal and political divisions.
Unless the policies that create the undeserving group are challenged, the group will be
institutionalized as a marginalized underclass (Schneider & Ingram, 1993). Adding
to their undeserving status is the converse institutionalization of the deserving group.
Over time, the deserving groups become stronger and the undeserving conclude that
this is simply how it is to be (Gaventa, 1988; Schneider & Ingram, 2003). It is,
however, possible for social constructions to change these perceptions. It requires a
person or group of people to champion the cause. This group has to create a voice for
the undeserving first, at a local level, and ultimately at a policy-making level
(Nicholoson-Crotty & Meier, 2003).
Constructionism has largely failed to form a coherent, singular paradigm.
Theorists have chosen to focus less on challenging established theoretical paradigms
and more on creating an applied theoretical perspective for the study of social
problems. The bases for social construction research are the stories, or narratives, of
individuals or groups of individual members of society. Social construction scholars
have divided these narratives into three types. The two primary categories are referred
to as P and p narratives. The lower-case p narrative refers to the narrative of
the ordinary folk. The capitalized P narratives are those told by professionals and
are designed for specialized audiences such as analysts and policymakers. Not
surprisingly, P and p narratives may vary greatly, even when pertaining to a same
38


or similar topic. For example, regulations in Colorado determine the number of
square feet each child in a residential treatment center must have in their bedrooms.
The P who determine these regulations believe they are requiring adequate living
space. The p who are living in this space may argue otherwise. The third category
of narrative is one which represents a blending of both the P and p views (Sarbin
andKitsuse, 1994).
The p group is frequently represented as those who will be most affected by
a policy or the defined group. The P group is frequently represented as the group
who is the definer. Because of issues of power, resources, and other external factors
between definers, defined, and policy-makers, there does emerge a dominant social
construction on a given issue. It is this dominant construction that generally dictates
the policy output. In this study, the p group would be the substance-abusing TANF
recipients. They are directly affected by the established policies, yet have little or no
voice in the policy-making, unless the P group chooses to allow them a voice. The
P group in this study are the county TANF administrators (State administrators
would also be in the P group, but are not part of this study). How they choose to
socially construct this issue will determine how the policies are constructed, as well
as who has a seat at the table when they are constructed. The TANF case workers
actually represent a blend of p and P given their interactions and roles with both
TANF recipients and administrators.
39


Deborah Stone (1997) views social construction as a necessary component
of decision-making as it provides a way to create the categories necessary for
calculation of consequences of policy decisions, as well as a way to assign various
values to those categories. Even more relevant is Schneider and Ingrams (1997)
social construction of target populations. Their work fundamentally addresses the
power relationship between the definer and the defined and its resulting social
construction (Ingram & Schneider, 1991; Ingram & Schneider, 1994; Schneider &
Ingram, 1993). They propose that policy-making systems identity target populations
and categorize them as deserving or undeserving and policy is then determined
accordingly. The deserving group is composed of the advantaged and the
dependents; the undeserving group is composed of the contenders and the deviants
(Schneider and Ingram, 1997).
Advantaged Contenders
Political Opportunity Risky
Risky Risky
DeDendents Deviants
40


Prior to welfare reform, welfare recipients were socially constructed as
dependents', therefore, they generally fell into the deserving group. Although there
was a societal perception that many welfare recipients were crack moms and
welfare mothers, the welfare policy was designed to not differentiate. Since all
welfare recipients were lumped together as one group, with no particular
administrative attention, but a fair amount of academic attention as to why some
recipients were remaining on welfare for extended periods of time.
PRWORA has forced this group to become administratively differentiated due
to the work requirements and other significant provisions of the law. There are those
who move off of the welfare roles quickly after some minor vocational assistance.
These are still viewed as deserving of benefits (e.g., childcare, food stamps, and
transportation assistance) as they are perceived as wanting to he self-sufficient and
merely suffering from circumstances beyond their control. In Schneider and Ingrams
matrix, they would be considered contenders.
There is another group that remains on or, possibly is unable to escape the
welfare roles. This group is characteristically emerging as one with substance abuse
issues, mental health issues, or physical disabilities. The latter two categories still
place them in the deserving albeit handicapped group, as they are perceived as
suffering from circumstances out of their control. Substance abusers, however, fall
squarely into the undeserving group, and are largely constructed as deviants who
should not receive benefits. Although in the mental health literature, substance abuse
41


is viewed as a mental illness, society, in general, maintains that it is a moral
weakness, and is less attentive or sympathetic to their needs.
Additionally, there exists a specific social construction paradigm, which
explains policy creation as it relates to the undeserving group labeled deviants. This
paradigm explains why issues related to certain groups of deviants are raised to a
policy level and why other deviant groups do not receive attention at a policy level.
The deviant group must be one with stereotypes that represent negative moral values
(Donovan, 2001). When determining the allocation of state resources, morally based
stereotypes are critical. Morally based stereotypes more easily get the negative
attention of the general public (Mucciaroni, 1995). The positive attention of the
public is critical to get momentum for any movement.
Further, when a group is stereotyped as morally deviant, they easily become a
target for sanctions. According to Edelman (1977), political opinion is most
influenced when beliefs are influenced about the problems, and moral condition of a
group whose very existence is viewed as a problem. When a group is viewed as
incorrigible, it is politically advantageous to create coercive sanctions (Cavender,
1982).
The next step that must occur to raise the deviant groups issue to a policy
level is there needs to be a moral entrepreneur. This person must bring attention to
the actions of the deviant group and convince others that these actions constitute a
threat to society (Ben-Yehuda, 1990; Kingdon, 1995; Nicholson-Crotty & Meier,
42


2003). Moral entrepreneurship stems from the nature of differential power groups in
society. Deviance, by definition, represents the differential between the values of the
larger, more powerful societal group and the values of the smaller less powerful
group (Gusfield, 1955; Becker, 1963). The efforts of the moral entrepreneurs
represent the values of the larger, more powerful group. Thus, they quickly gain
legitimacy (Goode & Ben-Yuda, 1994; Nicholoson-Crotty & Meier, 2003).
The final step is that a political entrepreneur must be secured to raise the issue
to the level of policy (Schneider & Teske, 1992). For these entrepreneurs to ensure
enough votes to win, they must have rewards or incentives to offer. Further, they have
to be able to create incentives for others as well (Kingdon, 1995). Likewise, other
political actors have to believe that there are political profits for them (Schneider &
Teske, 1992).
This paradigm fits nicely for the group recognized in this study. Substance
abusers in general, and certainly more so if they are mothers on welfare, are socially
constructed as moral deviants. Because this group receives public money, they have
certainly been raised to the attention of the general public. There have been multiple
moral entrepreneurs furthering the belief that this group is deviant. Finally, the
political entrepreneurs have created policies that sanction this group.
If the social construction of this group is to change, Nicholoson-Crotty &
Meier (2003) would argue that the different moral and political entrepreneurs will
need to gain prominence. They will need to educate on the disease nature of
43


substance abuse and the implications that should have on policy. However, one could
argue that the political entrepreneurs or the P are not the only ones who can create
movement of this group from deviant to contender. TANF case workers, who
represent a blend of p and P, could play a strong role in affecting change.
Social construction focuses strongly on how various groups are placed in the
various categories of Schneider & Ingrams (1993) matrix, but gives little attention to
how groups can move from one category to another. Nicholoson-Crotty & Meier
(2003) raise this concept of a political entrepreneur as a way to move groups from
one category to another more desirable category. However, their theory suggests the
entrepreneur is a P. It would be useful to expand the theory to include how certain
populations can move from one category to another without being dependent on a P
level individual or group. Perhaps, through the creation of dynamic coalitions that
champion a cause.
New Public Management fNPMt
As Max Weber (1905) pointed out close to a century ago, a bureaucratic
government was originally endorsed because it was seen as a movement towards
efficiency, effectiveness and protected the rights of its clients or citizens. Woodrow
Wilson, Fredrick Taylor, Chester Gulick, and also Bernard McGregor recommended
the need to motivate a bureaucratic government to achieve efficiency (Fry, 1989;
Raadschelder, 1998). A variety of theories and philosophies have evolved over the
44


years in an attempt to achieve efficiency. Most recently, the NPM movement is trying
to accomplish the same thing. NPM attempts to achieve this by insisting that
government services be competitive, mission-driven, customer-driven, results
oriented, enterprising, decentralized, and market-oriented (Osbourne and Gaebler,
1993; Lane, 2000; Atiyah, 1996, Osbourne & Waterson, 1994; Scharpf, 1997). NPM
draws upon the scholarly contributions from political science, economics, and
organizational theory (Hood, 1991; Walsh, 1995; Flynn, 1997), e.g., arguably, NPM
is part of the natural evolutionary process in public sector governance. NPM seems
to integrate the areas of public administration, public management, and policy theory
(Lane, 2000).
Although NPM is a worldwide phenomenon that originated with Margaret
Thatchers government (Peters and Savoie, 2000), it has become highly utilized in the
United States for the past two decades (Osbourne and Gaebler, 1993). The major
tenets of New Public Management are that government needs to be more cost-
effective, efficient, and responsive. This requires a more creative and entrepreneurial
approach. Often, the approach is to decentralize, reduce government, and privatize
functions that were previously conducted by government entities. Another keystone
of NPM is the definition of measurable standards of performance (Minogue,
Polidano, and Hulme, 1998). In theory, by creating competition through privatization,
and having measurable standards of performance to evaluate them, government
functions should be more efficient and effective. However, one could reasonably
45


argue that the added layer could create challenges to accountability. The additional
layer inherently creates more distance from the entity desiring the outcomes and the
actual people producing the outcomes. There are aspects of what the actual
performers of the outcomes are doing that even their organization does not
completely understand. Therefore, the ultimate governing organization will also not
have any knowledge of these activities (Kettl, 1995).
The United States government has undergone numerous attempts at
governmental reforms throughout its history, e.g., Jacksonian Politics, The New Deal,
and Progressive Era. The difference with NPM is there was an unprecedented citizen
demand for reform. Callahan and Holzer (1994) point out that government has never
been under such pressure for reform, nor has it been so willing. Additionally, unlike
other reform efforts, the states and local governments took the lead (Milakovich,
1993). Where other attempts at reform have failed, NPM arguably stands abetter
chance at long term success as its advociates claim it is grounded in sound
management practices and principles (Hatry,1993). Additionally, NPM recognizes the
need for changes at all government levelsfederal, state, and local in order for
there to be overall and lasting reform (Milakovich, 1993).
The processes and activities, which are grouped under the rubric commonly
referred to as NPM, are based on open systems models or philosophy of
organizational structure. The basic philosophy of an open systems model is that it is a
set of interacting elements designed to achieve a specific function (Hollings, 1996).
46


To many observers, A system is any set of related and interacting elements.
Relationships of some sort may be observed between virtually all objects of interest
to investigators. Some are trivial, some are important, and some involve interactions
among the objects. Only interactive relationships constitute systems. (Swanson &
Marsh, 1991, p. 23)
It is useful to understand the basic tenets of systems model. There are five
basic characteristics: each part of an organization can only be understood as it relates
to other parts of the organization; the parts of the organization, and their inter-
relationships are important as related to the overall functioning of the organization;
organizations can be though of metaphorically as biological organisms, which the
needs of the whole supercede the needs of the parts, the needs and goals can be
conceived both statically, and dynamically; organizational activity is understandable
in terms of its relationship to the external environment (Hollings, 1996). NPM
operationalizes the open systems philosophy through performance monitoring. One of
the first steps in reinventing government is an analysis of what the unit of government
should be doing, how it is doing it, and why it is doing it.
Fundamental economic and political changes worldwide have resulted in a
redefinition of the role of government and its relationship to the administrative state
during the last 25 years (Fox, 1998). Many governments have attempted some kind of
public reform with the concept of the public sector being multi-dimensional. New
Zealand has lead the movement for public-sector management reform. It sought a
47


new definition of the collective interest as a counterpoint to administrative
autonomy. While they recognized that the old notions of accountability were not
working, they recognized that something new and equally powerful had to replace
them (Kettl, 1995).
Some countries have tried one or two new public management type reforms,
while others have tried most all such as; decentralization, privatization, incorporation,
deregulation, internal markets, purchaser-provider split, and even tendering/bidding
schemes (Ferlie et al., 1996). Worldwide, national governments are either seeking
ways to provide social welfare services more effectively or relinquishing that
responsibility altogether in terms of privatization. A major reason for the change is
to cut costs and deficits by shrinking governments and to improve performance.
(Peter and Savoie, 2000).
There are also ideological motivations, such as a market approach competing
with the traditional public good orientation, that is, an efficiency versus an equity
orientation. The result is a call for the state to be run more like a business and an
unleashing of private capital to provide services more effectively and efficiently than
government has been able to do (Girdon, et al., 1992; Rockman, 1998). For example,
deregulation, which is a fundamental NPM tenet, is a natural result of globalization.
When national boundaries are removed, there is a leveling of the playing field
between public and private players. Thus, the traditional public regulation no longer
makes sense (Lane, 2000). However, this does not solve the aspect of public
48


regulation that is intended at protecting the public good. Deregulating could result in
the individual rather than public good being served at varying degrees.
Kettl (1993) discusses the difficulty in performance measurement when the
government contracts out services. Admittedly, the difficulty lies not only in the
contracting, but also in the nature of the services. As Kettl (1988, p.12) notes, The
government has taken on many functions.. .precisely because the private sector either
will not do them or would not do them in a way that respects competing values such
as equality, for instance, over efficiency. A strong state would hold its performance
accountable to an array of standards in particular, efficiency, effectiveness, personal
responsibility, accountability, responsiveness, and equity might conflict and therefore
require explicit trade-offs. These values and the trade-offs they imply would be much
more difficult to achieve where services are largely delivered by third parties
(Milward and Provan, 1993).
More specifically, Milward (1993) uses the term hollow state as a metaphor
referring to how health and human services are delivered in the United States. In the
hollow state model, the public headquarters are minimally staffed as the actual
services are largely contracted out. Various scholars have promoted variations on the
concept of the hollow state. Jennifer Wolch (1990) uses the shadow state to refer to
the increased role that nonprofits play in the delivery of human services to clients.
Donald Kettl (1988) and Steven R. Smith (1990) describe government contracting to
third parties as government by proxy and the contracting regime, respectively.
49


The dilemma is always that centralizing strengthens the policymakers control over
their subordinates. However, it weakens the ability of front-line workers to match
broad policy with the problems they find on a daily basis (Kettl & Dilulio, Jr., 1995).
The disconnect also can create accountability issues.
NPM is built on the notion that private-market incentives should drive public-
market incentives. Principal-Agent theory dove tails with the open systems
philosophy in that it maintains that organizations can be understood as a series of
relationships between principals who have work to be doneand agentswho
agree to do the work. The problem with typical relationships between principals and
agents is that the agents have more information than the principals, making
supervising for performance an on-going challenge, perhaps even with competition
while the principals are taxed with programmatic accountability (Miller, 1991). There
are three basic solutions to this struggle. Performance contracts, based on clear
definitions of goals, can set the standards by which they will be judged. Competition
among employees can establish incentives that supercede supervision. An
organizational culture that focuses on customer satisfaction can serve to drive service
from the bottom up (Kettl, and DiLulio, 1995). However, this does not entirely
control for customer service and performance. The more responsibility attributed to
the individual agents, the more the individual definitions of customer service and
performance of these agents become enacted.
50


It should come as no surprise that some of the basic NPM tenets have heavily
relied upon in the restructuring of Americas welfare system as mandated by welfare
reform. The traditional welfare system in the United States was perceived as having
become a large bureaucratic system that was unproductive for and, in many ways,
actually preventing its recipients from gaining self-sufficiency through its enabling
practices (Cox, 1999). This perception resulted in the need to reexamine how
government was conducting the business of welfare and the need to create a way in
which this public function could be conducted effectively (Fabricant and Burghardt,
1992). The NPM concepts of decentralization, competition, and results-oriented
government have been relied upon in this attempt at restructuring welfare (Hercik,
1998).
Osborne and Gaebler (1993) discuss New Public Management as being an
effort for public organizations to move from rowing organizations, which defend
their method at all costs, to steering organizations, which understand the effects that
macro-level management has on micro-level management. Welfare reform is an
example of such an attempt at organizational and cultural change (Hercik, 1998).
Several aspects of welfare benefits have been altered in an attempt to increase
efficiency via competition, decentralization, and a results orientation (Rom, 1999).
For example, part of the welfare benefits package has traditionally been food
stamps, or the effective food subsidization. Prior to Welfare Reform, food stamps
were paper coupons, which had specific dollar values marked on them. Although they
51


had certain restrictions (e.g., could not be used to purchase alcohol), welfare
recipients could use them in lieu of cash at grocery stores to receive food for their
families. To make this process more efficient, competition was created, as the federal
government put this service out for bid by private companies. This challenged the
bidders to create new and innovative methods for distributing food stamps in the most
efficient maimer. This service has now been completely overhauled as a result of
private contracting (Rom, 1999). The private contractor has changed food stamps into
cards resembling credit or debit cards. The allotted amount of money is automatically
credited on the recipients card each month. This card is safeguarded so that the
welfare recipient can only use it. Debit cards are more efficient, cheaper, and reduce
the risk of fraud. Additionally, they reduce stigmatization for the welfare recipient
who participated in the earlier and very public food stamp exchange. The new card is
not noticeably different than any other credit or debit card and they do not have to go
each month and physically pick up anything from the food stamp office.
Most importantly, the overall system of welfare delivery has been
decentralized in an attempt to make it a more effective system. The states are now
given much freedom in how they create their policies and implement them (Brodkin,
1997), and in some cases, it has been decentralized down to a county level. The NPM
thesis in this case is that if the overall welfare system is to be effective, it needs to be
flexible enough to adapt to various regional needs and differences. States are required
52


to follow certain broad federal mandates, but have a tremendous license to create
innovative policies and procedures for accomplishing their goals.
A key provision of PRWORA is that states are generally prohibited from the
use of cash assistance for families with an adult who has received cash assistance for
more than 60 months. Major components of the time limit policy are left to states
discretion. These include:
States can choose to exempt recipients from counting TANF receipt toward
the time limit and determine the criteria for granting such exemptions.
States can offer extensions of federally funded cash benefits beyond the 60-
month lifetime limit to families facing severe hardships, provided that such
hardship extensions do not exceed 20 percent of the states average monthly
caseload for adult-headed cases in the current or immediately preceding
federal fiscal year. States can also determine the criteria for granting
extensions.
States can choose to use state maintenance-of-effort funds to provide
assistance to families that have exhausted the 60-month time limit and can use
federal TANF funds to provide services that are defined as non-assistance to
recipients who have reached the 60-month time limit. Examples of non-
assistance aid are supportive services to employed recipients and work
subsidies to employers (Berkeley Policy Associates, 2001).
53


Further, states can choose to spend TANF dollars for substance abuse
treatment, and can choose to count treatment towards a recipients job training
obligations.
The welfare system has also become results oriented as a way to examine not
only its effectiveness but also its efficiency (Gordon, Jacobson, and Fraber, 1997). At
the macro-level, individual states have to be accountable to both the federal
government and their taxpayers, for the people that they are successfully moving
from welfare to work, as well as the reasons for why they are unsuccessful with
others. At the micro- level, individual workers have very specific time lines and
percentage expectations related to their clients successfully getting off of welfare
(PRWORA, 1996). All of these examples represent the dramatic shift that has
occurred in the business of welfare, as a result of welfare reform. At both the
macro- and micro-levels, the welfare agencies and their staff are being judged and
held responsible for the success of the TANF recipients.
In conclusion, the use of NPM tenets for the creation of Welfare Reform has
many positive outcomes such as, a more financially sound approach, and improves
the lives of many TANF recipients by helping them achieve self-sufficiency.
However, while the NPM approach to Welfare Reform holds states and, in some
cases, counties accountable in some areas, accountability in other areas simply cannot
be achieved due to the distance created through decentralization. For example, there
are sufficient exceptions to the rules, as previously discussed to allow for some
54


TANF cases to remain on the welfare roles long after their time is exhausted.
Furthermore, NPM simply cannot address the relationship issue that is inherent in the
business of Human Services. The importance of accountability of TANF workers
with regard to attitudes, and equal treatment of all TANF recipients is beyond the
scope of what NPM can address.
55


CHAPTER FOUR
METHODOLOGY
Introduction
By 2003, the first group of TANF recipients from the 1996 PRWORA
reached their mandated term limit for receiving financial and other assistance. TANF
was to sunset almost three years ago unless it was reauthorized. Congress, however,
has not been able to agree on a reauthorization law, so the original law has been
extended. Thus, the original requirements and time limits are still in place. The new
law is likely to increase work requirements, require all states to engage all clients in
work activities rather than a percentage, provide more money for child care, and
allow 3 months of substance-abuse treatment to count as a work activity.
In Colorado, eligibility rules are established by the state and are listed in the
Colorado Statutes at CCR 9-2503-1. Colorado also imposes two time lines, a 24-
month work activity participation time limit, and a 60-month lifetime limit on
assistance. However, each county has significant freedom in determining how to
administer TANF, including mechanisms in which to exempt certain families from
56


there will not be exceptions to the rules, it is increasing urgent for TANF offices to
effectively move all TANF recipients to self-sufficiency as quickly as they can.
As we have seen, it is clear that there are a significant number of substance-
abusing TANF recipients. Further, substance abuse is a tremendous barrier to
obtaining and maintaining employment and self-sufficiency. Research indicates that
substance abuse can be seen as a chronic illness that can be effectively treated leading
individuals to productive and self-sufficient lives (Kandel & Davies, 1990; Behn,
1995). Therefore, it becomes critical to identify accurately those substance-abusing
TANF recipients early in their program so that they can be effectively treated as a
first step to returning to the work force. From a policy perspective, there is a vested
interest in effectively identifying these individuals so that they can be referred for
treatment and successfully reenter the work force, thus meeting the overriding
PRWORA goal. The purpose and design of this research rests on the argument that
there is a relationship between accurately identifying substance abusing TANF
recipients and effectively administering TANF so that these individuals move off of
the TANF roles and into employment and self-sufficiency.
Social Construction Theory and NPM are complementary theories in
examining this issue. Social Construction Theory addresses the importance of the
relationship and personal interactions between the TANF recipients and case workers.
NPM addresses the challenges faced by the TANF administrators in creating policies
and procedures for effectively administering TANF.
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Researchers have long struggled between utilizing quantitative or qualitative
research methodology for any given study (King, Keohane, Verba, 1994). Often the
argument is made that quantitative is superior as qualitative is too soft and its
research findings are too limited. However, it is critical that the choice of
methodology be guided by the purpose and parameters of the study (Booth, Colomh,
Williams, 1995). Therefore, only after the purpose of the study has been determined
can the appropriate methodology be selected from ones methodological arsenal
(Lasswell, 1951). Additionally, the current literature and research in any given area
affect the type of methodology to be chosen. For example, a topic that addresses an
area rich in research and theory is best suited for a quantitative, deductive study.
However, a topic in an area that is more exploratory and relatively lacking in theory is
better suited for a qualitative, more inductive study. Quantitative research is inductive
in nature as it is designed to make predictions based on data that have previously been
presented. Qualitative research is deductive in nature due to its exploratory design.
Qualitative research covers a myriad of research forms such as field research,
naturalistic observations, case study, grounded theory, phenomenological approach,
ethnography, and life histories (Strauss & Corbin, 1998). The common thread among
all these forms of qualitative research approaches is that their goal is to capture the
essence or perceptions of phenomena from the viewpoint of those involved in the
process being studied. In comparison, quantitative methods are most comm only
58


utilized where there are large numbers of data that have a well-defined or
hypothesized relationship to a dependent variable (Cook & Campbell, 1979).
Qualitative research has been strongly established and supported by a number
of scholars such as Locke, Spirduso, and Silvermam (1993), Reisman (1994), Strauss
and Corbin (1990), and Glaser (1992). These scholars concur that qualitative research
is most appropriate when there is a need to study a phenomena where the perceptions
and experiences of those involved must be understood (Locke, et al. 1993).
Qualitative research is also most appropriate when studying a phenomenon where
there exists limited knowledge, little or no theory, and where quantitative methods are
difficult to use (Strauss and Corbin, 1990).
Reissman (1994) best summarizes the definition of qualitative research:
Qualitative data provide richness, diversity, accuracy, and contextual
depth. They can be used to characterize a group or process; uncover
the analytic ordering of the world being studied; develop categories for
rendering explicable and coherent the flux of raw reality; and locate
structure, order, patterns as well as variations (Reissman, 1994, p.33).
Although significant research on welfare and welfare reform has been
conducted (Morgenstem, 1999), the area of accurately identifying substance-abusing
welfare recipients is far from complete. There is neither adequate consensus nor
theory to address the large number of welfare recipients who have substance abuse
issues that are impeding their ability to maintain employment and self-sufficiency
(Nakashian, 2002). Therefore, this dissertation directly contributes to the
development of welfare policy and theory as it relates to the identification of
59


substance- abusing welfare recipients. As such, a qualitative approach is the most
appropriate methodology.
Design
An overview of the general research principles of qualitative research, field
research, and grounded theory approach is a necessary prelude. Guba (1978) is a
strong supporter of qualitative research, referring to it as Naturalistic Inquiry.
Gubas initial recommendations have been modified and enhanced over the years by
other advocates of qualitative research such as Erlander, Harris, Skipper, and Allen
(1993). Various scholars have written extensively on the various attributes of
qualitative study. Rubin and Rubin (1995) emphasize that qualitative interviewing
requires intense listening with a systematic effort to really hear what is being said.
In order to understand complex problems, the interviewer must be able to explore the
topic with their interviewees. Straus and Corbin (1998) discuss the importance of the
constant interplay between data collection and analysis, which occurs in qualitative
work.
Collectively, the guiding principles of qualitative research can be summarized.
First, qualitative research allows for extensive and comprehensive data to be collected
that can demonstrate the relationship between the data and the research propositions.
Second, in good qualitative research, the researcher is the primary instrument with the
research design emanating from the research itself. Third, tacit knowledge, such as
60


feelings, intuitions, or apprehensions, is treated differently, but on an equal basis with
proportional knowledge. Finally, it is argued that all theory should be grounded at
some point before it is applied, that is, it should be well substantiated through
research findings (Rubin & Rubin, 1995; Strauss & Corbin, 1998; Glaser & Strauss,
1999).
This dissertation utilizes the qualitative research approach of grounded theory,
specifically through the application of extensive fieldwork. Fieldwork is derived from
a traditional model of research where the research is conducted in a natural setting.
In contemporary fieldwork theory, the emphasis is not on where the work is
conducted, but rather on how the research is conducted (Morse, 1991). Emerson
(1983) explains that a key component to successful fieldwork is the researchers
ability to interpret accurately what they are observing. This requires a deep holistic
experience of learning about the fives, behaviors, and thoughts of others. The
researcher cannot uni-dimensionally examine the people, places, and conditions of
her area of study. The researcher must examine everything contextually. Emerson
(1983) further describes fieldwork as having not only the potential, but more likely
the probability of being a transforming experience for the researcher. If the
researcher truly examines the study from multiple perspectives, she cannot help but
develop a significantly deeper understanding of the area of study.
Although traditional fieldwork and contemporary fieldwork differ in emphasis
(with traditional fieldwork focused on where the study is conducted and
61


contemporary fieldwork focused on how the study is conducted), both call for the
researcher to obtain a holistic understanding of her observations. That is, she should
not only take in what was said, but also take the context as part of the research (
Booth, Colomb, & Williams, 1995). For the purposes of the present research,
contemporary fieldwork is the most logical choice. As Emerson (1983) discusses, it is
critical for the collection of good data to place emphasis on how it is collected rather
than where it is collected. This applies to this study as the emphasis is on the content
of what the interviewees have to say.
An adaptation of grounded theory research by Barney Glaser and Anselm
Strauss (1967) and Anselm Strauss and Juliet Corbin (1990) is utilized to strengthen
the research findings. Grounded theory methodology was originally developed by two
sociologists with very different, but complimentary backgrounds i.e., Glaser and
Strauss. Strauss came from a strong qualitative background (Glaser, 1992). Strauss
background provided the following contributions to the method:
.. .(1) the need to get out in the field, if one wants to understand what
is going on, (2) the importance of theory, grounded in reality, (3) the
nature of experience in the field for subjects and researcher as
continually evolving (4) the active role of persons in shaping the
worlds they live in through the processes of symbolic interaction, (5)
an emphasis on change and processes and the variability of and
complexity of fife, and (6) the inter-relationship between meaning in
the perception of the subjects and their action (Glaser, 1992,p.16).
Glaser came from a strong quantitative background and strongly concurred with
features in the above quotation.
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Strauss and Corbin (1990) define grounded theory with an emphasis on it
being a theory that is inductively derived from the study of the phenomena that it
represents. It is to be discovered, developed and verified through a systematic
collection of data and the analysis of those data as they pertain to the phenomena.
This means that the data collection, analysis, and theory have a reciprocal relationship
to one another. That is, one does not begin with a theory and then prove it. Rather,
one begins with an area of study and what is relevant to that area is allowed to
emerge. (Strauss & Corbin, 1990, p. 23).
The ultimate goal and purpose of grounded theory, then, is to allow the theory
to emerge through the research process itself. To that end, the focus is to develop as
many diverse and relevant theoretical categories as possible based on the data that
emerge as the research is conducted. Concisely, grounded theory is a process of
discovering and understanding meaning while concurrently generating theory.
This dissertation utilizes a modified version of the grounded theory approach
by allowing the reviewed theoretical frameworks to construct general interview
categories that guide the initial direction of the study. This adapted version of
grounded theory incorporates the concept of utilizing related literature, thus deviating
slightly from the empty slate concept recommended in traditional grounded theory
research. Glaser and Strauss (1967) indicate that initial sampling choices can be made
based on a preconceived theoretical framework. The research process itself, not pure
logical deduction, determines whether preliminary theoretical categories are relevant
63


as well as what other categories are pertinent to this dissertation. The preliminary and
general theoretical categories are subject to change, of course, and may possibly be
eliminated based on data collected and the research findings. In addition to changes
and elimination, new theoretical categories may be created to accommodate observed
trends that emerge from the research.
To specify and clarify the definitions of the concepts being studied, a
comparative analysis of TANF recipients was used to generate conceptual categories
and properties of the study. Essentially, comparative analysis uses the logic of
comparison to analyze empirical data and, therefore, generate theoretical categories
and properties to guide the study to the level of discovering and understanding
meanings from the data (Glaser & Strauss, 1967). Unlike quantitative research that
seeks to verify an aggregate result pattern, qualitative research strives to understand,
interpret, and report the diversity and variations that occur from the phenomenon
being studied (Strauss & Corbin, 1990; Emerson, 1983).
The comparative analysis will be conducted using the NUD*IST computer
software. NUD*IST is designed to analyze qualitative data for patterns, trends, and
common themes. It is a multi-functional software system for the development,
support and management of qualitative data analysis projects. It is used in a wide
range of research for handling non-numerical unstructured data by processes of
indexing, searching, and theory building (www.pugh.co, 2001).
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It is useful to briefly explain how NUD*IST works, and how it was utilized
for this particular study. NUD*IST is a computer package designed to aid users in
handling non-numerical and unstructured data, the sort of data that is made by
interviews, field notes, collections of documents, focus group notes or simply messy
field notes about an event or problem. The program offers tools to assist interpretation
and coding, or indexing. NUD*IST allows for the creation of new text documents, as
well as for importing existing documents. The analysis can be accomplished a
number of different ways. It allows for common themes to emerge, and for cross-
references or intersections to be examined.
NUD*IST is not a general purpose statistical software package for the social
sciences; rather, it is a program for qualitative data analysis projects. NUD*IST is
used for a wide variety of tasks from complex theory constructing and testing to very
quick analysis of small or large bodies of text in focus group summaries or open-
ended answers in surveys. It is designed to automate much tedious work, swiftly
auto-coding text and importing table data, and all processes can be done by
command file (www.indiana.edu, 2001).
In addition to the comparative analysis of TANF recipients, another grounded
theory analysis approach was employed. Case studies of four Colorado counties were
conducted. The case studies permitted the researcher to see if these counties seemed
to be very similar or very different in their approaches to administering TANF.
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The purpose of grounded theory is to propose theory that consists of
categories relevant to the area of study. This purpose fits with Gubas overall
qualitative research principle where the design emerges as the investigation
proceeds (Guba, 1978, p.14). The identified categories allowed the researcher to
attempt to generate and propose a theory that may contribute to the understanding of
how to better identify substance abusing TANF recipients. This could ultimately
contribute to future TANF policy as it relates to substance abusing TANF recipients.
Flyvbjerg (2001) would endorse grounded theory in the study of social
sciences. He points out that the study of social phenomenon cannot be effectively
studied in the conventional scientific manner as they are context dependent. Whereas
theory in the natural sciences is predictive, theory in the social sciences is context
dependent. Further, social science theory accounts for human activity, which cannot
be reduced to a set of rules (Flyvbjerg, 2001).
In summary, grounded theory is the most appropriate methodology for this
thesis due to the integrated nature of this research and the goal of grounded theory.
Clearly, this is a research area that does not currently reflect a strong theory base.
Grounded theorys purpose is to allow theory to evolve from the study, thus
potentially resulting in the ability to enhance the field, as well as create policy
implications.
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Research Guidelines
Qualitative research requires research guidelines that define and guide the
research (Morse, 1991). Based on the theoretical frameworks previously discussed,
several research propositions are presented. These propositions are guided by the
over-arching area of study, which is how can TANF case workers accurately identity
substance- abusing TANF recipients.
The research propositions are:
1) It is possible for welfare offices to better identify substance abusing TANF
recipients. The research indicates that identification numbers of substance
abusing TANF recipients vary greatly state to state (Speiglmann &
Kappagoda, 2000). Failure to identify accurately will make it difficult for
substance abusing TANF recipients to receive the services necessary to obtain
self-sufficiency.
The use of screening instruments combined with adequate staff training,
higher educational level of staff and various other identification techniquessuch as,
red flag checklist, urinalysis, drug and alcohol education, substance counselors on-
site, and home visits- will result in a more accurate percentage of substance abusing
TANF recipients being identified.
Substance abusers in general, but especially females with children are viewed
by society as morally deficient (Hirsch, 1999). Although some, when in an
environment that they perceive as non-judgmental, will ask for help, others will not.
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Admission and/or identification do not occur in one visit with one questionnaire. To
that end, the more different approaches taken to identify and the more skilled the
workers are who are making these attempts, the more success they will realize
(Nakashian and Moore, 2000).
2) There exist facilitators and baiTiers (cultural, sociological, etc.) to identifying
substance abusing TANF recipients (Focus Group, The Haven, 1999; Focus
Group, Women in Need, 2000, Hercik, J.M., 1998; Nakashian & Moore,
2000). To the extent these barriers exist, TANF workers will be limited in
their ability to deliver substance-abusing TANF recipients appropriate
services so that they can achieve self-sufficiency.
The government units whose stated policy is that a TANF applicant or
recipient who admits to substance abuse, initially receives treatment, as opposed to
being penalized, will have more success in effectively identifying substance abusing
TANF recipients.
This hypothesis addresses Social Construction Theory as it examines the
impact of how substance abusing TANF recipients are socially constructed. Counties
whose policy is to remove benefits from TANF recipients or applicants who
acknowledge or are identified as substance abusing are socially constructing them as
deviants. As Ingram and Schneider (1993) point out, the overwhelming message that
deviants receive is that they are bad people whose behavior is a problem for
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others and unless they somehow change or avoid contact with the government, they
will be punished. Substance-abusing TANF recipients are living with a disease
whose resulting behaviors they are unlikely to change independently. They would
most likely prefer to avoid the government system of welfare, but to do so puts them
at risk of homelessness or involvement in another government system, such as
criminal justice. Counties whose policy is to offer treatment for TANF recipients or
applicants who acknowledge or are identified as substance abusing are socially
constructing them as dependents that are deserving of assistance. If a TANF recipient
believes that she is viewed as worthy of and will receive assistance, she is more likely
to ask for help or at least comply with the requirements.
3) It is possible for policy makers and administrators to create policies and
procedures that assist in better identification of substance abusing TANF
recipients.
The decentralization and performance driven focus of welfare will result in
superior identification of substance abusing TANF recipients by allowing counties the
ability to create innovative and entrepreneurial approaches.
This hypothesis addresses New Public Management (in particular the
principal-agent aspect of NPM) as it examines the impact that different approaches to
the administration of TANF have on effectively identifying substance abusing TANF
recipients. PRWORA essentially set guidelines and timeframes that states had to
move people from welfare to work, but gave states tremendous freedom to determine
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how best to accomplish their goals. Since Colorado is a county-administered state,
welfare is decentralized to a county level. Therefore, each county will vary in its
policies and procedures, the amount of contracting out they do, and how they measure
performance. This study will allow for the examination of these various approaches
and tie them to the results being obtained.
Sampling
There are many possible sampling options for this study, such as convenience,
opportunistic, or extreme case (Marshall & Rossman, 1989).However, purposive or
judgmental sampling is preferred. Babbie (1998) suggests that purposive sampling
offers a good choice when the researcher has significant knowledge of the population
as is the case in this dissertation. Erlandson et.al., (1993) states that purposive
sampling is central to naturalistic research; e.g., random sampling is not the method
of choice as the goal of the research is not to generalize. Rather, the goal is to
discover patterns and problems that occur in a particular context. Purposive sampling
allows for a broad range of data to be exposed, hence maximizing the researchers
ability to find common themes (Babbie, 1998; Erlandson et.al., 1993).
Strauss and Corbin (1990) explain theoretical sampling as sampling based on
concepts that have proven theoretical applicability. There are two guiding principles
for theoretical relevance. First, a concept is relevant if it either repeatedly presents
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itself or is noticeably absent. Second, a concept is relevant if through coding
procedures it earns the status of category.
While Glaser and Strauss (1967) endorse initial sampling choices being made
based on a preconceived theoretical framework, subsequent choices should be guided
by the theoretical relevance of concepts. Emerson (1983) further states that additional
data are collected and new observations pursued to look for analytically relevant
concerns rather than to establish the distribution or frequency of phenomena.
Sampling continues until the researcher has reached a saturation point. Saturation
occurs when the same concepts, themes, information are consistently reappearing and
no new information is being obtained (Glaser and Strauss, 1967).
Another benefit of purposive sampling for the present purpose is flexibility.
Flexibility refers to the ability to change the direction of the samples chosen based on
the data that emerge. In this study, data most likely will emerge that change who
and/or where data may need to be collected. Strauss and Corbin (1990) support the
need for flexibility in the sampling method of choice while conducting grounded
theory research.
For any analysis to result in good information for policy recommendations,
the target population must be clearly identified. Schneider and Ingram (1993) define
the target population as a group selected for change in policy as a function of
behavioral change. The target population selected for this study is female substance-
abusing TANF recipients. To capture the inherent complexity of this situation, the
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unit of analysis for this thesis is two-fold, comprised of a comparative analysis of
TANF recipients, and case studies of four Colorado County TANF agencies. The
sampling criteria are determined based on this authors previous work in this area (see
Preface), This previous work presented the opportunity to interview TANF recipients
for the comparative analysis, as well as interview TANF administrators and case
workers and review TANF assessment instruments for the case studies. Additionally,
an extensive literature review on substance abuse has been conducted (See Chapter
2).
Based on the previous work and review of theoretical frameworks, we can
posit that there are multiple contributing factors that make the identification of
substance abusing TANF recipients particularly difficult. For example, many TANF
recipients believe that they will be penalized rather than getting assistance if they
disclose substance abuse problems so they are less than forthcoming, thereby
obscuring the diagnosis. The way that some counties and/or states design their TANF
policies can make this perception a legitimate concern. That is, if the TANF recipient
does disclose substance abuse, she must comply with treatment or risk being
sanctioned. The selected sampling characteristics are designed to explore the various
areas that are believed to have a direct effect on TANF workers ability to accurately
identify substance abusing TANF recipients.
Both Glaser and Strauss (1967) and Strauss and Corbin (1990) explain that the
sample size is determined by the principles and guidelines of theoretical saturation.
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Theoretical saturation is determined by three guidelines. First, saturation occurs when
no new or relevant information is thought to be emerging. Second, the category
development is dense. That is, there does not seem to be any significant gaps between
categories. Finally, the relationships between categories are well- established and
validated. Without theoretical saturation, any theory that emerges will be
conceptually inadequate or incomplete.
Although some states uniformly administer welfare policy throughout the
state, in Colorado, each county has the mandated responsibility of establishing its
own welfare policy. This decentralized approach allows for a tremendous amount of
variation between counties in how welfare policy is administered. Therefore, the
four counties chosen for the case study portion of the analysis represent variation in
size, population served, i.e. predominant ethnicity, urban area, and rural area, and
format of administering TANF.
For this thesis, the county selection was determined by the requirement to
have geographical variation, with both urban and rural representation. It was
estimated that a sample of four Colorado counties would be adequate to achieve
representation in various geographical areas of Colorado, as well as recognizing both
urban and rural conditions. The counties studied are Denver, Adams, Arapahoe, and
El Paso. Denver represents a very urban county. Adams and Arapahoe are close
proximity to Denver, but these counties consist largely of suburban areas, as well as
very rural areas. El Paso comprises the city of Colorado Springs, which does have a
73


town center, but is more suburban in nature. Additionally, El Paso county consists
largely of the more rural areas in and around Pueblo.
The case study of each county involves interviews with a county
administrators and case workers who represent various levels of TANF. The
interviews will be conducted TANF case workers, and TANF administrators, as well
as reviewing written intake and assessment documents for each county agency. The
comparative analysis of TANF recipients was achieved through conducting semi-
structured interviews with TANF recipients from the counties that were case studied.
Interviews continued until saturation was achieved. After twenty interviews, it was
evident that saturation had occurred.
To obtain access and co-operation on the part of TANF agencies, it was
necessary to obtain administrative support for each county. The author has developed
a professional relationship with a top administrator of Denver County Social Services.
As Denver is the largest Social Services agency in the state, it is a logical choice as
one of the counties to study. Additionally, this contact in the City and County of
Denver was able to serve as a liaison and introduction to obtain research approvals in
other counties. However, once contact is made with the various individuals and
agencies, it was be the authors responsibility to obtain formal consents from all
participants.
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Observation Methods
This thesis involves a combination of data collection methods. As Flyvbjerg
(2001, p.58) points out .some people who do not possess theoretical knowledge are
more effective in action (especially if they are experienced) than others who possess
it. Thus, this research utilizes the primary data collection methods of elite
interviewing, semi-structured interviewing, and document review. It also employs the
secondary data collection methods of questionnaires. The secondary data reflects data
collected by the county agencies. This allows for the limitations in one method to be
compensated for by the strengths in another method (Marshall & Rossman, 1989).
Utilizing the variety of data collection methods should allow for a comprehensive
review of each county studied.
The first data collection method to be utilized was a review of each county
TANF agencys intake and assessment documents. The reviewing of intake and
assessment documents served as a necessary introduction and supplement to the
subsequent interviews conducted. It serves to provide verification as to how the
policies are actually written, which will be a valuable point of comparison as to how
the interviewees perceive various policies. It also serves to indicate what forms and/or
policies are actually in place to assist with the identification of substance-abusing
TANF recipients. The documents to be reviewed originate from the individual agency
and include:; intake questionnaires, interviews and forms used by TANF workers
with TANF recipients. These documents provide data to address the proposition
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regarding what facilitators and barriers exist in trying to better identify substance-
abusing TANF recipients.
Interviewing is a necessary data collection method as it allows for the
collection of large amounts of data in a timely manner. Interviews can range from
conversations to highly structured and standardized (Patton, 1990). Qualitative
interviews tend to be more like conversations than formal events (Marshall &
Rossman, 1999). This dissertation employs interviews with three types of TANF-
affiliated personsadministrative, staff, and recipientsall of which were semi-
structured. As previously mentioned, the administrator and case worker interviews
were for the purpose of the case studies while the TANF recipient interviews were for
the purpose of the comparative analysis.
Elite interviews constitute the first set of interviews with an N of 4 for the four
targeted counties. Elite interviews are interviews with top administrative officials
(Marshall & Rossman, 1999). This is the logical beginning as the first contact was
with a top administrator Of Denver County Social Services and in other counties as
well. The focus of the administrator interviews was to leam how welfare reform
policies were determined and implemented in each county studied. Further, this
approach gathered information on how the administrators perceive policies being
followed, if policies to assist with the identification of substance abusing TANF
recipients have been developed, and, if so, what were the determining criteria for
developing the policies. These interviews should address the proposition regarding
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what policy makers and administrators can do to help better identify substance
abusing TANF recipients. See Table below for the categories and probes for the elite
interviews.
Table 4.1 Interview Structure for Elite Personnel
1. Background Information
How long have you worked for this human service agency?
Have you worked in other human service agencies in Colorado?
If so, how were they similar?
If so, how were they different?
What other positions have you help in human services?
What is your educational background?
Is there any other relevant experience you would like to contribute?
1. Welfare Reform
What do you believe to be the purpose of Welfare Reform?
In what ways has Welfare Reform changed the agency?
What have been some of the implementation struggles with Welfare
Reform?
In what, if any, ways has Welfare Reform improved substance abuse
services for clients?
In what, if any, ways has Welfare Reform interfered with substance
abuse services for clients? .
2. Organizational Culture
What did you perceive the agency mission to be prior to Welfare
Reform?
What do you perceive the agency mission to be after Welfare Reform?
How has Welfare Reform changed your job?
3. Policy
What new substance abuse policies have been created as a result of
Welfare Reform?
What substance abuse policies have been changed as a result of
Welfare Reform?
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What substance abuse policies have been eliminated as a result of
Welfare Reform?
Have substance abuse policies received any more or less attention than
other related issues such as mental health or domestic violence?
What is the agency policy if a TANF recipient is identified to have a
substance abuse problem?
4. Training
Did you receive any training on the dynamics of substance abuse
identification and treatment?
5. Substance Abuse Identification
Are there procedures in place to attempt to identify substance abusing
TANF recipients?
If so, what are they?
Do you believe that substance abuse among TANF recipients is a
problem?
6. Demographics
Gender?
Age?
Ethnicity
The second set of interviews for the case studies was with TANF case workers
with an N of 4. The focus of these interviews is to ascertain not only what practices
they utilize, but also their views on TANF recipients and their views on what could be
done differently. These questions are designed to reveal what, if any, deliberate
efforts or activities are being conducted to identify substance abusing TANF
recipients. These interviews should provide data to address the propositions related to
what barriers exist for TANF workers in the identification of substance abusing
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TANF recipients. These interviews will also capture information about their years of
experience, educational level, and specialized training they and attended. The
researcher will interview TANF the case worker recommended by the TANF
administrator. See Table 3.2 below for the categories and probes for the TANF
worker interviews.
Table 4.2 Interview Structure for TANF Staff
1. Background Information
How long have you worked for this human service agency?
Have you worked in other human service agencies in Colorado?
If so, how were they similar?
If so, how were they different?
What other positions have you held in human services?
What is your educational background
Is there other relevant experience you would like to contribute?
2. Welfare Reform
What do you believe to be the purpose of Welfare Reform?
In what ways has Welfare Reform changed the agency?
What have been some of the implementation struggles with Welfare
Reform?
In what, if any, ways has Welfare Reform improved substance abuse
services for clients?
In what, if any, ways has Welfare Reform interfered with substance
abuse services for clients?
What programs are available for substance abusing TANF recipients?
3. Organizational Culture
What did you perceive the agency mission to be prior to Welfare
Reform?
What do you perceive the agency mission to be after Welfare Reform?
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How has Welfare Reform changed your job?
What various functions is your job responsible for performing?
4.
Policy
What new substance abuse policies have been created as a result of
Welfare Reform?
What substance abuse policies have been changed as a result of
Welfare Reform?
What substance abuse policies have been eliminated as a result of
Welfare Reform?
Have substance abuse policies received any more or less attention than
other related issues such as mental health and domestic violence?
What is the agency policy if a TANF recipient is identified to have a
substance abuse problem?
5. Training
Did you receive any training on the dynamics of substance abuse
identification and treatment?
6. Substance Abuse Identification
Are there procedures in place to attempt to identify substance abusing
TANF recipients?
If so, what are they?
Do you believe that substance abuse among TANF recipients is a
problem?
7. Demographics
Gender?
Age?
Ethnicity?
The final set of interviews is with TANF recipients. These interviews were for
the comparative analysis. To adequately address the comparative analysis aspect of
this research, it was necessary to have sufficient interviews with TANF recipients to
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reach saturation. After twenty interviews with TANF recipients, it was evident that
they were responding to the various questions with extreme similarity. Thus,
saturation had occurred.
As with the other interviews, there must be consent on the part of the
interviewee. In the case of TANF recipients, there appears to be greater and more
forthright participation if the interviews are conducted in an individual format with
TANF recipients in some form of substance abuse treatment. This is due to the
possibility that participants who are not in treatment may not feel comfortable
disclosing substance abuse information if they have not done so with their TANF
worker. Additionally, the participants were informed that the interviews were
confidential. The researcher had an added assurance that she obtained significant and
straightforward participation. As a Licensed Clinical Social Worker having worked
with this population, the researcher had the clinical interviewing skills necessary to
conduct these interviews effectively.
The purpose of the TANF recipient interviews is to ascertain how TANF
recipients perceive the TANF system specifically, what they believe is and is not
being done to identify substance abusing TANF recipients. Also, what they believe
would help in better identification. These interviews provide data to address the
proposition regarding what facilitators and barriers exist in preventing substance
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abusing TANF recipients disclosing their substance abuse. See Table 3.3 below for
the categories and probes of the TANF recipient interviews.
Table 4.3 Interview Structure for TANF Recipients
1. Background
How did they end up on TANF?
How long have they been on TANF?
Is this their first time on TANF?
Have they every received or are they receiving other human service
services?
2. Welfare Reform
What do you believe to be the purpose of Welfare Reform?
Describe the process of accessing TANF.
What was helpful I the process?
What was not helpful in the process?
What benefits were offered to you?
Were there any benefits not offered to you that you later learned
existed?
3. Organizational Culture
How do you perceive that you were treated throughout your TANF
process?
How helpful are the TANF workers in addressing your needs?
What, if anything, would you change about the general culture/attitude
in the agency?
4. Substance Abuse Identification
What, if any, efforts are made to identify substance abuse among
TANF recipients?
Do you believe that substance abuse is a problem among TANF
recipients?
If so, to what degree?
What would make a TANF recipient want to disclose a substance
abuse problem?
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What would prohibit a TANF recipient from disclosing a substance
abuse problem?
All interviewees were asked to read and then sign the standard consent form
approved by the University of Colorado at Denver Human Research Committee. The
form explains the fact that all interviews will be transcribed, as well as confidentiality
issues. All the interviews typed and entered within one week of the interview. This
time frame is critical as one of the tenets of grounded theory is that data should be
entered as close to collection as possible (Miles & Huberman, 1988).
The final data collection method to be employed for the case studies was that
of questionnaires. The purpose of the questionnaires is primarily to obtain
information that assists in describing the population interviewed, as well as the
population TANF agencies serve. One questionnaire will be given to the
administrators, which merely asks demographic information on the TANF recipient
population (See Table 4.1).
Validity. Reliability, and Limitations
Validity and reliability are of great concern in any study, whether qualitative
or quantitative. Qualitative studies especially have an inherent risk to threats of
validity and reliability due to the level of subjectivity and flexibility in data
collection. Indeed, Maxwell (1996) suggests that qualitative proposals should have a
separate section devoted to examining how the researcher could be wrong in their
findings. Locke, Spirduso, and Silverman (2000) suggest that there are three major
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threats to validity in qualitative research that the researcher must address. First,
descriptions and context of participants must be accurate. Second, personal biases
must be addressed in a manner so as not to hinder or obscure results. Third, the
researcher must plan for how participants reactions to the researcher may impede the
acquisition of data.
In order to address the first concern, this researcher took great efforts to make
descriptions as objective as possible by recording statements of the interviewees and
not the researchers opinions. Due to this researchers professional work in the
substance abuse field, as well as pilot work done related to this study, maintaining
accurate context should be attainable. Further, by analyzing actual county forms and
documents, descriptions and context are assured.
The second concern was addressed much like the first in that it required
remaining as objective as possible. While this researchers work in this arena was an
asset with regard to maintaining contextual accuracy, it was a potential hindrance in
maintaining perfect objectivity. This was best addressed by the use of the previously
discussed constellation of data collection methods. Additionally, NUD*IST is
designed to objectify qualitative data. The combination of questionnaires, document
review, and interviews prevents the data generated from being solely dependent on
the researchers observations.
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For the purpose of this study, the researcher created text documents for each
of the interviews conducted. As was evident in the sample interviews presented
previously, each of the administrator and case worker sets of interviews questions
were asked in similar categories. By creating parallel interviews, it allowed for
similar themes or concepts to emerge across these two interviewee roles, as well as
across counties (these concepts are listed in Chapter Five). The researcher was able to
then create Nodes for each of the concepts. A node is a NUD*IST term for placing
similar test units together. For example, one of the themes that emerged was Barriers
to Substance Abuse Identification. All test units that related to this theme we coded
under this node. Nodes were also created for each county and for each interviewee
role. By creating these various nodes, the researcher was able to examine the data
within counties, across counties, within interviewee roles, and across interviewee
roles. Data was cross examined using the NUD*IST analysis feature called
Intersection. Intersection finds the test units that are indexed or coded by all of the
given set of two or more nodes. Similarly, for the comparative analysis of the TANF
recipients, nodes were created such that the common themes could emerge.
As with any study, inter coder reliability must be accounted for. For this
study, the researcher solicited the assistance of a NUD*IST consultant, Christi
Jackson. Ms. Jackson is a qualitative data consultant in the Denver area, and is
extremely familiar with NUD*IST. The researcher explained the study and data
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collection to Ms. Jackson and asked that she review the coding and analysis for
accuracy and thoroughness.
The third area of concern is addressed in multiple ways. The biggest concern
in this area is that data would not be provided due to participants fear of disclosure.
The design of this study is such that confidentiality and anonymity is maintained.
This begs the question of whether or not participants are confident of that assurance.
Pilot work for this study suggests that they either do, or are not concerned with this.
Pilot focus groups and interviews conducted with TANF recipients, case workers, and
administrators freely answered questions and offered unsolicited information
(Nakashian and Moore, 2000).
The variety of data collection methods selected were done so as to increase
the construct validity of the study. Each method has various strengths and weaknesses
( Marshall and Rossman, 1999) and collectively represent the vast majority of
potential strengths.
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\
Table 4.4
Strengths and Weaknesses of Data Collection Methods
Strength 0 / DR Q
Fosters face-to-face interactions with participants X
Useful for uncovering participants perspectives X
Data collected in natural setting X X
Facilitates immediate follow-up for clarification X
Good for documenting major events, crises, social conflicts X X
Collects data on unconscious thoughts and actions
Useful for describing complex interactions X X
Good for obtaining data on nonverbal behavior and communication X
Facilitates discovery of nuances in culture X X
Provides for flexibility in formulation hypotheses X X
Provides context information X X X
Facilitates analysis, validity checks, and triangulation X X X X
Facilitates cooperation
Data easy to manipulate and categorize for analysis X X
Obtains large amounts of data quickly X
Allows wide range of types of data and participants
Easy and efficient to administer and manage X X
Easily quantifiable and amenable to statistical analysis X X
Easy to establish generalizability X
| May draw on established instruments X X
Key: OObservation, I=lnterview, DR=Document Review, Q=Questionnaire Marshall and Rossman, 1989
87