Enrollment Decisions in a Child Development Accounts Program for Low-Income Families

This exploratory study analyzed factors that influenced parental decision to enroll in a child development accounts program for their pre-school children’s college education. Data used is from a savings demonstration program in a Midwestern U.S. state. Of the individual, household and service-level variables, only the level of parent’s education and the program orientation about the accounts offered to parents were significantly associated with enrollment decision. Analyzed variables explained 79.0% of the decision to enroll. Results provide limited support for an institutional mechanism to help low-income families participate in child development savings accounts program. Implications are directed towards program and policy implementation of similar programs.     

Restrictiveness of Eligibility Determination and Medicaid Enrollment by Low-Income Seniors

Medicaid is an important source of supplemental health care coverage for low-income seniors, yet little is known about the effect of state policy on Medicaid enrollment by eligible elderly. Data from a nationally representative survey were used to examine Medicaid enrollment by elderly, low-income Medicare beneficiaries living in states that liberalize or restrict Medicaid eligibility criteria using the 1986 Omnibus Budget Reconciliation Act or provision 209(b) of the 1972 Social Security Act Amendment, respectively. Controlling for demographics and health status, residence in states applying these laws was significantly, though modestly, associated with Medicaid enrollment. Additionally, 73% of eligible elderly Medicare beneficiaries were not enrolled in Medicaid, and most have serious chronic health problems. These findings suggest that a significant number of eligible elderly are not enrolled in Medicaid and that liberalizing or tightening Medicaid eligibility criteria can have an impact on Medicaid enrollment by low-income elderly patients.     

Child care subsidies and care arrangements of low-income parents

While enrollment into early education programs has increased significantly in the past two decades, many low-income children still do not attend these programs due to lack of funding and access. This study uses data from the 2005 National Household Education Survey to examine the effects of child care subsidies on the enrollment of low-income children in early childhood education programs. Multinomial regression results show that families that receive child care subsidies are more likely to place their child in center-based preschool programs. The analyses also show that subsidy receipt increases the probability of using center care for low-income households. These findings indicate that policies aimed at increasing funding and availability of early education for low-income families can help close the gap in enrollment.     

The Effects of the State Children’s Health Insurance Program on Insurance Status and Health Care Utilization of Children

The State Children’s Health Insurance Program (SCHIP) of 1997 aimed to increase public insurance eligibility to children in families that were above the Medicaid income cutoff line, but were too poor to afford private coverage. This paper shows that SCHIP helped as many as 1.3 million children leave the ranks of the uninsured. However, almost 400,000 of these children came from families with two privately insured parents, and added approximately $300 million in health care expenses to federal and state budgets. This paper also presents estimates of health care consumption of children who switched to public insurance as a result of SCHIP.     

Examining Recruitment Follow-Up Phone Calls and Their Influence on Attendance for Husbands and Wives in a Marriage and Relationship Education Program

Low-income married couples face unique stressors that contribute to increased relationship distress. Federal funding has supported research initiatives aimed at studying how marriage and relationship education (MRE) influences the relationships of low-income married participants. However, research identified recruitment and retention of low-income participants as a major obstacle to the replication of these programs. Therefore, this study examined programmatic data from 786 low-income married participants to investigate how recruitment follow-up influenced attendance in the MRE program. A weak, inverse relationship was found for women between the number of pre-enrollment phone calls made and hours spent in MRE. We found a statistically significant difference between who was contacted (wife, husband, or both) and attendance to the initial intake appointment for program enrollment. Implications and future research are discussed.     

SCHOOL SELECTION PREFERENCES OF PUBLIC AND PRIVATE UNIVERSITY MSW STUDENTS: A RETROSPECTIVE STUDY

A convenience sample of MSW students responded to an Internet-based survey (N=2,289) retrospectively reporting their reasons for enrolling in a specific social work graduate program. Reponses indicate that MSW students who enroll in private graduate programs are younger and reported reputation-related and employment-related reasons for specific school selection more often than students enrolled in public schools. Students enrolled in public schools reported location-related reasons as more important. Bifurcation of the applicant pool into private and public preference-groups presents a recruitment challenge. Other findings include that enrollment rates are substantially higher than previously anticipated, which suggests that most applicants to graduate social work programs are likely to be admitted if they apply to multiple programs.     

Meeting the Service Needs of Young Fathers

Until the early 1980s, the needs of young fathers went largely unnoticed by policy makers and social service providers. Many programs for adolescent fathers originally started in order to benefit teenage mothers and their children (Leitch et al., 1993). It was later recognized that young fathers also need assistance to successfully become productive and responsible adults (Robinson, 1988; Leitch et al., 1993; Kiselica, 1995). Program designs have been based on a set of implicit assumptions: 1) if programs are offered, young fathers will enroll; 2) the services will meet the needs of participants; 3) once young men enroll in a program, they will use the services that are available; and 4) the services will be beneficial for recipients and will produce positive outcomes (Kiselica, 1995; Children and Youth Funding Report, 1998; Smith, 1997; DeParle, 1998). However, only limited research has been conducted to explore whether these assumptions are appropriate or to document programmatic successes and difficulties (Achatz and MacAllum, 1994; Marsh and Wirick, 1991; Sander, 1993). This paper adds to the literature by reviewing each of the assumptions within the context of one program's experience. It considers issues associated with outreach and enrollment, service delivery, and achieving desired outcomes for program participants.     

Health Care innovation and children in poverty: lived experiences of caregivers of children with disabilities in a medicaid-serving ACO

This paper reports the results of a qualitative study of caregivers of children with disabilities enrolled in a Medicaid-serving accountable care organization (ACO). The state of Ohio mandated ACO enrollment for Medicaid-eligible children with disabilities in 34 of 88 counties effective July 2013. Research participants were queried in focus groups and individual interviews about their children’s care experiences and care coordination after enrollment. Most told researchers that they themselves are their children’s care coordinators, and many indicated that resource scarcity is a more pressing problem than fragmented care. Data analysis identified a theme of scarcity and four categories of insufficiency that made caregiver efforts on behalf of their children more difficult: a lack of health services under managed care, resource constraints on other agencies and programs for which families were eligible, a lack of financial support, and a lack of family support. A conceptual framework places ACO care coordination among more upstream factors and identifies ways in which ACOs serving Medicaid populations may wish to address the social determinants of the well-being of children with disabilities. Implications for future research are discussed.     

Sexual Abuse Prevention Concept Knowledge: Low Income Children Are Learning but Still Lagging

School-based child sexual abuse (CSA) prevention programs have proliferated since beginning over 30 years ago. Research on program effectiveness has emphasized summative outcomes while under-reporting implementation and process fidelity, limiting reliable comparisons across programs and populations. External validity is further limited by racially and economically homogenous samples, or a failure to report such demographics. This article presents data from a CSA prevention program delivered to 2nd and 3rd grade public school children. A formative concept and item level analysis on the Children’s Knowledge of Abuse Questionnaire at baseline and four week follow-up, as well as fidelity and implementation data, are reported. Results show that children learn and retain certain concepts, but vary widely in knowledge across items. This sample of low-income, minority children also show lower baseline and “learned” abuse prevention knowledge compared to published norms, which is not attributed to implementation variability. These data give critical insight into workshop effectiveness that is masked in summative reporting, yet essential to adapting and strengthening school-based CSA programs. Knowing the long-term consequences of adverse childhood experiences and disparate health outcomes linked to race and socioeconomic status, it is imperative to adequately assess CSA prevention program impact across diverse populations.     

Correlates of Participation in a Family-Based HIV Prevention Program

Abstract

This study examines the relationship between contextual factors and attendance in a family-based HIV prevention program for low-income, urban, African-American women and their children. Participants' motivations to become involved, their concerns about discussing sex-related issues with their children, recruiters' perceptions of respondents' understanding of the program, and environmental stressors were examined. Participants' level of motivation and recruiters' success in improving respondents' understanding of the program were significant correlates of attendance. Stressors experienced by the family and concerns around talking with children about sex were not significantly associated with participation. Recommendations to enhance involvement in family-based HIV prevention programs are made.     

Effects of Employment-Based Programs on Families by Prior Levels of Disadvantage

This study examines how welfare and employment policies affect subpopulations of low-income families that have different levels of initial disadvantage. Education, prior earnings, and welfare receipt are used to measure disadvantage. The analysis of data from experiments suggests that employment-based programs have no effects on economic well-being among the least-disadvantaged low-income, single-parent families, but they have positive effects on employment and income for the most-disadvantaged and moderately disadvantaged families. These programs increase school achievement and enrollment in center-based child care of children only in moderately disadvantaged families. The most-disadvantaged families are found to increase use of child care that is not center based. Parents in these families experience depressive symptoms and aggravation. The findings raise questions about how to support families at the lowest end of the economic spectrum.     

SNAP EXPANSIONS AND PARTICIPATION IN GOVERNMENT SAFETY NET PROGRAMS

This paper investigates the interactions between health and nutritional assistance programs such as Medicaid, SNAP, WIC, and school lunch programs. Exploiting variation in SNAP eligibility across states and over time, I find strong evidence of program interactions: when a state moves from the federal rule to the most extensive SNAP eligibility rule, enrollment in free school lunch and WIC increases by 4.1 and 7.9 percentage points, respectively. I estimate that the federal government spends an additional 74 cents on the school lunch program and WIC for each dollar spent on SNAP due to the expansion. (JEL H53, I38, J22)     

Predictors of public early care and education use among children of low-income immigrants

Little is known about predictors of publicly funded early care and education (ECE) use among low-income children of immigrants. Without this knowledge, it is difficult to effectively increase participation in these public programs, which promote school readiness but are underused by children of immigrants. Using nationally representative data from the Early Childhood Longitudinal Study – Birth Cohort (ECLS-B), this study attempts to identify pertinent family, child, maternal ECE preference, broader contextual, and immigrant specific characteristics predictive of ECE use among 4-year-old children in a sample of low-income children of immigrants (N ≈ 1050). Specifically, we estimate multinomial logistic regression models predicting type of ECE (Head Start, public pre-k, subsidized ECE, unsubsidized ECE, parental care) from these characteristics. Findings suggest that even in a low-income sample, correlates of disadvantage such as low maternal education and prior receipt of public benefits are important predictors of public ECE use, as are maternal preferences for certain features of care and supply-side factors such as ECE availability. Immigrant-specific factors such as English proficiency, citizenship status, availability of non-English speaking caregivers, and generosity of state policies toward immigrants emerged as particularly salient for explaining the public ECE selection patterns of low-income immigrants. Results point to future research areas and potential policy solutions aimed at increasing public ECE use for children who may stand to benefit the most.     

Factors Impacting Group Long-Term Care Insurance Enrollment Decisions

This paper examines factors that influence whether or not employees choose to enroll in a group long-term care insurance plan. A conceptual family decision-making framework is used to group factors to study the enrollment decision of 509 state employees who were offered a long-term care insurance plan in 2000. Logistic regression results revealed that employee age, perceived risk, perceived affordability, decision-making style (communication with others and use of information), goals of control and choice, goal of financial peace of mind, household income, and potential caregiver availability explained 68.7% of the decision to enroll. Results support the key role of perception, specifically the perceived risk of needing long-term care and the affordability of the insurance plan, in the decision outcome.     

Perceived facilitators and barriers to saving among low-income youth

Asset-based social welfare programs focus on helping low- to moderate-income citizens to accumulate wealth in the form of homeownership, savings, small businesses, and higher education. Individual development accounts, savings accounts in which account holders’ deposits are matched, are a vehicle often used in these programs. In a national demonstration of individual development accounts for children (children's savings accounts), low-income youth were interviewed to learn what helped them to save and what made it difficult to save. We describe the young people's perceptions of these factors, and conclude with implications for policy and program design.     

The effects of economic instability on children's educational outcomes

Welfare Based on Assets, a Way to Smooth Out Economic Instability and Develop Children's Human Capital is a four-part series of papers that focuses on the relationship between economic instability (i.e., income shocks, asset shocks, home loss, and asset poverty) and children's human capital development. Collectively, these reports build on the compelling observation that the pattern low-income families walk into is a present time oriented or consumption based pattern of behavior; in contrast, the pattern higher income families walk into is future oriented or asset based. In the third paper we find in most cases income shocks and asset shocks do not appear to be harmful to children's educational outcomes. However, children living in liquid and net worth asset poor families have lower academic achievement scores, high school graduation rates, college enrollment rates, and college graduation rates than children living in families that are asset sufficient. Overall, findings can be interpreted as suggesting that a bifurcated welfare system, with income-based programs for poor families and asset-based programs for higher income families, may provide higher income families with an educational advantage over low-income families and might ultimately help exacerbate educational inequalities in America.     

Expanding health insurance for children: examining the alternatives

This Issue Brief examines the issue of uninsured children. The budget reconciliation legislation currently under congressional consideration earmarks $16 billion for new initiatives to provide health insurance coverage to approximately 5 million of the 10 million uninsured children during the next five years. Proposals to expand coverage among children include the use of tax credits, subsidies, vouchers, Medicaid program expansion, and expansion of state programs. However, these proposals do not address the decline in employment-based health insurance coverage--the underlying cause of the lack of coverage, to the extent that a cause can be identified. What is worse, some proposals to expand health insurance among children may discourage employers from offering coverage. Between 1987 and 1995, the percentage of children with employment-based health insurance declined from 66.7 percent to 58.6 percent. Despite this trend, the percentage of children without any form of health insurance coverage barely increased. In 1987, 13.1 percent were uninsured, compared with 13.8 percent in 1995. Medicaid program expansions helped to alleviate the effects of the decline in employment-based health insurance coverage among children and the potential increase in the number of uninsured children. Between 1987 and 1995, the percentage of children enrolled in the Medicaid program increased from 15.5 percent to 23.2 percent. Some questions to consider in assessing approaches to improving children's health insurance coverage include the following: If the government intervenes, should it do so through a compulsory mechanism or a voluntary system? Is the employment-based system "worth saving" for children? In other words, are the market interventions necessary to keep this system functioning for children too regulatory, too intrusive, and too cumbersome to be practical? In addition to reforming the employment-based system, what reforms are necessary in order to reach those families who have no coverage through the work place? Which approaches are both efficient and politically acceptable? Employment-based coverage of children will likely continue. The challenge for lawmakers is to find a way to cover more uninsured children without eroding employment-based coverage. Several current legislative proposals attempt to avoid this problem by excluding children who have access to employment-based coverage. Without such a requirement, the opportunity to purchase coverage at a discount would create incentives for some low-income employees to drop dependent/family coverage, which in turn could lead some employers to drop their health plans.     

How parents decide to participate and save in their children's asset-building accounts: Implications for practice, policy, and theory

Asset-based social welfare programs focus on helping low to moderate income citizens accumulate wealth in the form of home ownership, savings, small businesses, and higher education. Individual development accounts, savings accounts in which account holders' deposits are matched, are a vehicle often used in these programs. In a national demonstration of children's savings accounts (individual development accounts for children) parents participated in focus groups to discuss how they decided to enroll in this asset-building program, how they decided to open accounts for their children, and how they saved in these accounts. Findings from this study have implications for assetbuilding policy and practice, and institutional theories of saving.     

Targeting the young,the poor,the less educated: thinking beyond traditional media

The research presented in this article focuses on ways to communicate pro-social messages to often overlooked and underserved societal subgroups. Specifically, the research focuses on methods of disseminating information to low-income persons lacking reading skills or a high school education (or its equivalent) to encourage them to enroll in classes provided by a state’s adult education (AE) programs.The results of the research suggest that traditional mass media may not be the most appropriate or efficient information channels for public relations and other communicators wishing to convey such pro-social messages to similar audiences. If mass media are employed, it may be necessary to rethink both the content and the intended receivers of such messages.