Concern for families reaching the time limits imposed under welfare reform has led states to develop strategies for addressing the needs of this hard-to-employ population. Ramsey County, in the St. Paul area of Minnesota, implemented the Intensive Integrated Intervention project to reduce the number of families that would reach that limit without employment or other sources of economic support. The intervention's focus on assessment and intensive case management revealed that many recipients demonstrated low cognitive functioning, along with serious physical and mental health problems, which often made it difficult for recipients to complete even the most basic activities of daily living and challenging for parents to rear their children effectively. This report finds that despite the extreme difficulties program staff uncovered, they believed that, with the right services and supports, most recipients could eventually work. However, staff ended up granting numerous time-limit extensions and transferring many recipients to the Supplemental Security Income rolls because funding was insufficient to sustain the intensive interventions they believed necessary to help recipients make a lasting transition to unsubsidized employment. In addition, staff realized the importance of a proactive approach to identify recipients whose personal and family circumstances contribute to their inability to participate and succeed in traditional welfare employment program activities.