"The physical and mental health problems of these adults and children are substantial and significantly hinder a family's attempts to transition from welfare to permanent work and economic security," says co-author Dr. Linda Burton, professor of human development and family studies and sociology at Penn State. "Our data suggest that the health problems of parents and children are integrally linked and solutions developed by state an federal policymakers should comprehensively address both economic and health issues of families."
Burton, Debra Skinner, research scientist, University of North Carolina, Chapel Hill; Stephen Matthews of Penn State; and William Lachicotte, UNC-Chapel Hill, presented their findings today (Aug. 17) at the annual American Sociological Association meeting. Their ethnographic study is part of a larger on-going project, "Welfare, Children and Families: A Three-City Study," where researchers at eight universities are monitoring the consequences of welfare reform on the lives of 2,400 families in Boston, Chicago and San Antonio.
Ethnographic research teams observed families' day-to-day activities and the influences impacting their interactions with school, work, family ad government and health care agencies. Of the 254 families, 42 percent were Latino or Hispanic, 40 percent were African American; and 20 percent were White. Forty-nine percent were receiving welfare assistance benefits; of that subgroup, 16 percent were working, following welfare work requirements. The other 51 percent not receiving welfare were working poor or unemployed.
The 1996 Personal Responsibility and Work Opportunity Reconciliation Act instituted the current welfare reform, with a new program Temporary Assistance for Needy Families (TANF), which limited the time that families can receive public assistance and installed work requirements PRWORA also decoupled TANF and Medicaid, requiring families to qualify for both programs separately.
Approximately 83 percent of the caregivers - usually a biological mother - were 39 years old or younger; and nearly all had at least one child 2 to 4 years of age. For primary caregivers, common physical health conditions included diabetes, heart disease, severe obesity and arthritis accompanied by mental health concerns such as depression, anxiety or stress. For children, the researchers also found a range of serious conditions such as severe chronic asthma, seizures or leading poisoning coupled with depression, autism or attention deficit hyperactivity disorder (ADHD), for example.
"The fact that many of these caregivers face health problems usually associated with older, frail individuals, is very troubling," Burton notes. "Also, we found that most of these caregivers tended to neglect their own health needs to meet the economic and health care needs of their children and extended family."
The 254 families in the study included 42 families selected specifically because they had children with moderate to severe disabilities. Co-author Skinner, who directed the disability component, found similar challenges with 83 percent reporting concurrent physical and mental health problems in both the primary caregiver and at least one child.
"We were surprised at the high rate of poor health of mothers and other family members," Skinner says. "For the most part, these families do a tremendous job of piecing together services for their children and garnering the emotional and physical resources needed to support their families. However, these efforts take a physical and emotional toll."
The researchers also studied how all the families coped with seeking employment, fulfilling welfare work requirements and trying to maintain their family's health. Caregivers worked despite having serious health problems, but frequently, they reported having lost or resigned from jobs because of health-related responsibilities. Also caseworkers did not always provide clear and consistent information about individual programs, and differed in their expectations whether the adult's health problems qualified for an exemption from the work requirements or an extension of TANF eligibility, Burton notes.
Insurance coverage was uneven across the non-disability families with 40 percent fully insured by Medicaid, private insurance or some combination of the two; 60 percent were partially or uninsured. Of the disability families, 74 percent were fully insured and 26 percent were partially inured.
While Medicaid is working for many people, there are gaps in coverage and access to services, the researchers say. Complicating factors affecting private and public insurance coverage included grandparents without legal custody of the children; caregivers working low-wage jobs with no health benefits; caregivers' inability to pay deductible and co-insurance costs; and job schedules and transportation difficulties when traveling to appropriate offices to apply for Medicaid or other types of health insurance.
"There is no single reason for why families are failing to receive the proper assistance," Burton and Skinner note. "It's the convergence of all these forces that create unworkable situations for families. These early findings highlight several key points that should be considered in the current welfare reform reauthorization debate and any further reforms in welfare assistance, Medicaid and employee health insurance benefits."
Full reports of "Welfare, Children and Families: A Three-City Study" are posted at http://www.jhu.edu/~welfare/ Burton, Skinner and other researchers in the project will publish these and other findings in two fall reports sponsored by the Kaiser Commission on Medicaid and the Uninsured.
The ethnographic study received funding from a variety of federal and private sources including: National Institute of Child Health and Human Development; Assistant Secretary for Planning and Evaluation, U.S. Dept. of Health and Human Services; Social Security Administration; the John D. and Catherine T. MacArthur Foundation; the Robert Wood Johnson Foundation; and the Henry J. Kaiser Family Foundation.