More than half of New Yorkers receiving welfare benefits face significant obstacles preventing them from entering the workforce. These barriers range from medical conditions, both physical and mental, to substance abuse issues, age limitations, and caregiving responsibilities. Recognizing these complex challenges, the Human Resources Administration (HRA) has launched WeCARE, a comprehensive initiative designed to systematically address the health and other multifaceted issues hindering welfare recipients’ employment prospects. This ambitious program aims to refer approximately 45,000 clients annually to specialized contractors who offer tailored employment services for individuals with disabilities.
While even critics of welfare reform acknowledge the genuine obstacles faced by current beneficiaries, there are still unanswered questions surrounding the specifics and potential effectiveness of WeCARE. While the recognition of barriers is a positive step, the program’s details require closer examination to fully address the concerns of welfare recipient advocates and ensure its success.
What Makes WeCARE Different?
The WeCARE program distinguishes itself through its initial “biopsychosocial” assessment. This comprehensive evaluation encompasses a medical examination, various tests, and an in-depth interview exploring the client’s psychological and social background. Based on this thorough assessment, clients are then placed into one of four distinct tracks: immediate engagement in work-related activities, expedited application for federal disability benefits, medical treatment for existing health conditions, or vocational rehabilitation services aimed at long-term employment.
This approach bears a resemblance to the city’s earlier PRIDE program, which operated between 1999 and 2004 with the similar goal of transitioning welfare recipients with disabilities into the workforce. During its four and a half years, PRIDE assessed nearly 37,000 participants, resulting in approximately 5,800 finding employment and 3,100 successfully obtaining federal disability benefits.
However, WeCARE introduces key differences. Under WeCARE, welfare applicants or current clients are referred to private contractors specializing in disability employment services as soon as a potential employment barrier is identified by city workers. From this point forward, all assessments, services, and ongoing case management are consolidated under a single contractor or their designated subcontractors. This contrasts with the PRIDE program, where city workers retained significant case management responsibilities for clients with special needs.
A significant enhancement for individuals with disabilities within WeCARE is the introduction of new medical providers tasked with evaluating and developing personalized treatment plans for health conditions that can be stabilized or improved. The previous clinic utilized by the HRA was often criticized by clients for being dismissive of their disability reports, even when supported by medical documentation from their personal physicians. Similar to PRIDE, participation in WeCARE mandates adherence to prescribed medical treatment plans, with program staff monitoring client compliance to ensure active engagement in their health improvement journey.
Beyond these core changes, many elements of WeCARE are built upon existing practices. In recent years, the city has already implemented screening processes for welfare applicants to identify disabilities, substance abuse issues, literacy gaps, English language proficiency limitations, and experiences of domestic violence. Staff members have been expected to refer clients to relevant support services based on these screenings. Individuals reporting disabilities were previously directed to a clinic for medical and psychological evaluations. Those deemed capable of working were then referred to external contractors for “skill assessment and placement,” and, when necessary, for job preparation and skills training programs.
The Challenge of Effective Screening for WeCARE Candidates
A critical aspect of WeCARE’s success hinges on the Human Resources Administration’s ability to accurately and effectively identify individuals who would benefit most from the program. Effective disability screening necessitates interviewers who are adept at explaining the potential advantages of disclosing a health condition or disability. These benefits include access to enhanced medical treatment and vocational services, the possibility of securing employment accommodations tailored to their specific needs, and legal protections against discrimination in the workplace.
Historically, New York City’s welfare reform initiatives have not always been characterized by patience, client respect, or proactive encouragement of service utilization. The PRIDE program, for instance, primarily relied on welfare applicants to self-report their physical or mental disabilities to job center personnel.
This self-reporting approach likely overlooked a significant number of individuals who were aware of health conditions that hindered their ability to work, but were unaware that these conditions legally qualified as disabilities under the Americans with Disabilities Act (ADA), thus entitling them to workplace accommodations. For example, individuals with chronic conditions like arthritis or back pain may not be aware of potential workplace modifications that could enable them to work without experiencing debilitating pain. Similarly, those with conditions like lupus or sickle cell anemia, which may necessitate frequent sick days, might not realize they are entitled to support. Even individuals with diabetes may require specific workplace accommodations, such as refrigerated storage for medication and scheduled break times for meals.
Furthermore, a subset of the population, both within and outside the welfare system, may not even recognize that they have a disability that significantly impairs their work capacity. Mental health conditions, for instance, can profoundly complicate the job search process, participation in vocational training, and navigation of the complex procedures within the Human Resources Administration. The persistent stigma associated with mental illness often contributes to a widespread reluctance to acknowledge and address these conditions.
Adding to the complexity, individuals often face multiple, overlapping barriers to employment. Substance abuse or domestic violence issues might be the most immediately apparent challenges. However, if a client lacks trust in service providers, and the providers are not trained to look for a broader range of issues, underlying physical or mental health conditions could remain undiagnosed and untreated, rendering other interventions ineffective and hindering long-term progress.
Privacy Considerations in Biopsychosocial Assessments
WeCARE’s emphasis on initiating the process with a biopsychosocial assessment, preceding any vocational evaluation, raises important privacy considerations. Unless a client explicitly claims a disability that will impede their ability to engage in work activities, welfare agency staff cannot automatically assume that a visible disability inherently constitutes a barrier to employment. Mandating an applicant to undergo medical testing and answer intrusive questions about their psychological history as a prerequisite for receiving welfare benefits is legally problematic and ethically questionable.
No individual is legally obligated to disclose a disability to a WeCARE intake worker if they choose not to. According to the New York State Department of Labor guidelines, welfare applicants and beneficiaries cannot be compelled to undergo medical assessments and treatment unless the government possesses “reasonable cause” to believe that the client’s disability will prevent them from working. The Department of Labor further suggests that a documented history of unsuccessful attempts at work activities is typically required before medical examinations and treatment can be mandated as a condition of receiving benefits.
However, waiting for demonstrable failure in work activities before intervention can be inefficient and detrimental, both financially for the city and emotionally for the clients. This reactive approach can perpetuate a cycle of individuals cycling through the welfare system without receiving the timely and appropriate support they need. Research from the Manpower Demonstration and Research Corporation indicates that welfare recipients who lose benefits due to sanctions are statistically more likely to have significant barriers to employment compared to other recipients. The Corporation advocates for an integrated approach combining treatment and work support, similar to the model proposed by WeCARE, while emphasizing the critical need for long-term monitoring of clients to prevent setbacks during periods of relapse or personal crises.
Ensuring Quality Training for Job Trainers
The responsibility for delivering the majority of WeCARE services is entrusted to two primary contractors: Federation Employment and Guidance Services (FEGS), covering Manhattan, the Bronx, and Staten Island, and Arbor Education and Training, responsible for Queens and Brooklyn. Both organizations possess prior experience in providing employment services under contracts with New York City.
A potential area for improvement lies in the staffing strategies of these contractors. Neither organization appears to be prioritizing the recruitment of professionals with disabilities to serve as job trainers and mentors within the WeCARE program. Disability awareness and understanding are often best fostered through lived experience. Without personal or direct professional experience working with individuals with disabilities, frontline staff may inadvertently rely on stereotypes, oversimplify complex situations, and apply standardized, one-size-fits-all solutions that fail to meet the unique needs of each client.
Job descriptions posted online by both FEGS and Arbor indicate that some managerial positions require education or experience in working with people with disabilities. However, similar requirements are notably absent for the frontline staff who will be directly interacting with and providing support to WeCARE clients on a daily basis.
Arbor, for example, plans to hire “intake specialists” to conduct the crucial “psychosocial assessments” of new clients entering the program. Intriguingly, the stated qualifications for these intake specialist positions may not extend beyond a high school diploma, despite the significant responsibility of interviewing clients and generating comprehensive summaries of their medical, psychological, and social histories. These reports will likely play a pivotal role in determining the trajectory of each client’s participation within the Arbor WeCARE system.
Medical Compliance as a Potential Hurdle
The medical component of WeCARE, embodied in the Wellness/Rehabilitation Plan, is central to the program’s goal of improving clients’ health to a level that enables them to pursue and maintain employment. WeCARE is designed to connect clients with appropriate medical providers, offer case management and health education, and actively monitor client adherence to their prescribed doctors’ instructions and treatment plans.
A crucial question remains regarding the potential consequences of non-compliance. It is unclear whether WeCARE case managers will be tasked with submitting reports that could ultimately lead to the loss of welfare benefits for clients who fail to adhere to their medical treatment plans. While WeCARE staff are also intended to support clients in complying with treatment, their effectiveness in this role is contingent on building trust and fostering understanding with their clients.
WeCARE must realistically anticipate that some clients, like patients in any healthcare setting, will struggle to consistently follow doctors’ instructions. Research studies estimate that even when medications are prescribed to individuals with chronic diseases characterized by recognizable symptoms, patients adhere to the prescribed regimen only 60 to 70 percent of the time. Even within the medical profession itself, medication errors and non-compliance occur approximately 20 percent of the time. Understanding and addressing the multifaceted reasons behind medical non-compliance will be crucial for WeCARE’s success in improving client health outcomes and facilitating their return to work.
WeCARE in the Context of Federal Welfare Reform Reauthorization
After years of delays, the United States Congress is poised to readdress the reauthorization of the Temporary Assistance to Needy Families (TANF) program, the federal legislation that underpins welfare reform initiatives across the country. Certain factions within Congress are advocating for stricter work requirements for welfare beneficiaries, even though the individuals currently remaining on welfare rolls are demonstrably those who face the most significant barriers to securing and retaining employment. Current federal law mandates that states must have at least half of their welfare cases engaged in defined “work activities.” Proposed legislation in the House of Representatives seeks to increase this work participation requirement to 70 percent of cases.
As of February 2005, approximately 36 percent of New York City’s Family Assistance recipients were engaged in work. The currently mandated workweek is part-time, and proposals to mandate full-time work participation raise concerns that such requirements could prevent welfare recipients from engaging in other valuable activities that do not qualify under the stringent federal definition of “work.” For individuals with disabilities, a part-time work schedule is often the most essential and effective workplace accommodation, allowing them to manage their health conditions while remaining productive.
The city has already conveyed to Congress that escalating work participation requirements will inevitably necessitate increased federal funding for work support services, including programs like WeCARE. Imposing higher work requirements without commensurate increases in support services could inadvertently undermine the progress achieved through recent welfare reform efforts and compromise the effectiveness of initiatives like WeCARE that are designed to address the complex needs of welfare recipients with significant barriers to employment. The future success of WeCARE will depend not only on its internal program design and implementation, but also on the broader policy landscape shaped by federal welfare reform and the availability of adequate resources to support its mission.
Linda Ostreicher, a former budget analyst for the New York City Council, is a freelance writer and consultant to nonprofits.
