Knowledge of welfare reform program provisions among families of children with chronic conditions

Child Only Kinship Care Cases:The Unintended Consequences of TANF Policies for Families Who Have Health Problems and Disabilities

The passage of the Personal Responsibility Work Opportunities Reconciliation Act (PRWORA) in 1996 changed the way America sought to help its most vulnerable citizens. The Temporary Assistance for Needy Families (TANF) legislation required families to work first. Many families with young children found the stringent requirements of TANF too restrictive for their needs. In this study a number of TANF customers were either physically ill or suffered mental health problems thus preventing them from finding suitable employment. Additionally they may have children who have health problems, which preclude the parent from work activity. Faced with time limits these families may rely on relatives or fictive kin to assume the responsibility of receiving TANF grants for the children so that they may avoid sanctions and possible loss of support for their children. These arrangements are called child-only cases. Given that poverty is related to neglect and neglect may result in out of home placement, these children are at risk for child welfare intervention. Child welfare systems look to kin to assume the responsibility of child rearing to reduce the number of children especially African American children who enter care. However, TANF and informal arrangements for kin to take care of children result in substantially less money for families. An evaluation of TANF is needed to determine if this legislation provides an adequate system for caring for needy families and children. doi:10.1300/J045v22n03_04.

Health insurance and length of stay for children hospitalized with community-acquired pneumonia

BACKGROUND

Disparities in patterns of care and outcomes for ambulatory-care sensitive childhood conditions such as community-acquired pneumonia (CAP) persist. However, the influence of insurance status on length of stay (LOS) for children hospitalized with CAP remains unexplored.

METHODS

Secondary analysis of children (<18 years) hospitalized with CAP sampled in the Kids' Inpatient Database (KID) for years 1997, 2000, 2003, and 2006. Insurance status (private, public, uninsured) was based on claims data. Hospital LOS was calculated in days. Taking into account the complex sampling design, negative binomial regression models produced adjusted estimates of incidence rate ratios (IRR) for hospital LOS for children by insurance status.

RESULTS

There was little variation in the categories of insurance status of children hospitalized with CAP between 1997 and 2006, with at least 40% privately insured, at least 40% publicly insured, and at least 5% uninsured in each sampled year. In all years, publicly insured children had a significantly longer hospital stay than privately insured children, and uninsured children had a significantly shorter hospital stay than privately insured children. These observed differences persisted after multivariate adjustment.

CONCLUSIONS

Differences in LOS between uninsured, publicly insured, and privately insured children with CAP raise concerns about potential differences in hospital discharge practices related to insurance status and type. As healthcare reform is implemented, policy makers should strengthen efforts to reduce these disparities in order to achieve health for the population.

What do women know about government services and benefits?

This article examines how much women know about government services and benefits and discusses why this type of knowledge matters. Using data from a survey as well as focus groups conducted in Montreal and Toronto, we show that the women who are most likely to need information about these programs are often the least likely to be aware of them. This is especially true of low-income women, older women, and women who came to Canada as immigrants. We end by suggesting some steps that could be taken to address these knowledge gaps.

Barriers to Medicaid enrollment: who is at risk?

OBJECTIVES

We identified factors associated with levels of knowledge about Medicaid eligibility rules and perceived Medicaid enrollment barriers.

METHODS

Community health center patients who were parents of children potentially eligible for Medicaid (n=901) were interviewed in person during their clinic visit between April and December 1999.

RESULTS

Individuals reporting physical health problems were more likely to be misinformed as were non-Hispanic Black individuals, compared with non-Hispanic White individuals. In states where more policies had been enacted to simplify Medicaid enrollment procedures, individuals were less likely to be misinformed. Individuals reporting mental health problems, those with less education, and women were more likely to perceive Medicaid enrollment barriers. Prior experience in Medicaid was associated with both a reduced risk of perceiving Medicaid enrollment barriers and being misinformed.

CONCLUSIONS

Findings highlight target groups for whom additional outreach and additional simplification policies may be most needed.

Why pediatricians need lawyers to keep children healthy

Pediatricians recognize that social and nonmedical factors influence child health and that there are many government programs and laws designed to provide for children's basic needs. However, gaps in implementation result in denials of services, leading to preventable poor health outcomes. Physician advocacy in these arenas is often limited by lack of knowledge, experience, and resources to intervene. The incorporation of on-site lawyers into the health care team facilitates the provision of crucial legal services to vulnerable families. Although social workers and case managers play a critical role in assessing family stability and finding appropriate resources for families, lawyers are trained to identify violations of rights and to take the appropriate legal steps to hold agencies, landlords, schools, and others accountable on behalf of families. The incorporation of lawyers in the clinical setting originated at an urban academic medical center and is being replicated at >30 sites across the country. Lawyers can help enhance a culture of advocacy in pediatrics by providing direct legal assistance and case consultation for providers, as well as jointly addressing systemic issues affecting children and families. Until laws to promote health and safety are consistently applied and enforced, pediatricians will need lawyers to effectively care for vulnerable children.

Employment barriers among welfare recipients and applicants with chronically ill children

OBJECTIVES

This study evaluated the association of chronic child illness with parental employment among individuals who have had contact with the welfare system.

METHODS

Parents of children with chronic illnesses were interviewed.

RESULTS

Current and former welfare recipients and welfare applicants were more likely than those with no contact with the welfare system to report that their children's illnesses adversely affected their employment. Logistic regression analyses showed that current and former receipt of welfare, pending welfare application, and high rates of child health care use were predictors of unemployment.

CONCLUSIONS

Welfare recipients and applicants with chronically ill children face substantial barriers to employment, including high child health care use rates and missed work. The welfare reform reauthorization scheduled to occur later in 2002 should address the implications of chronic child illness for parental employment.