Meeting the Multifaceted Needs of Expectant and Parenting Young Families Through the Pregnancy Assistance Fund.

INTRODUCTION: The Pregnancy Assistance Fund (PAF) program funds states and tribes to provide a wide range of services to improve health, social, educational, and economic outcomes for expectant and parenting teens and young adults, their children, and their families. This introductory article to the Maternal and Child Health Journal supplement Supporting Expectant and Parenting Teens: The Pregnancy Assistance Fund provides a description of the PAF program, including the program goals and structure, participants and communities served, and services provided; presents data on the reach and success of the program; and describes lessons learned from PAF grantees on how to enhance programs and services to have the best outcomes for expectant and parenting young families. METHODS: Performance measure data are used to describe the reach and success of the PAF program, and implementation experiences and lessons learned from PAF grantees were gathered through a standardized review of grantee applications and from interviews with grant administrators. RESULTS: Since its establishment in 2010, the PAF program has served 109,661 expectant and parenting teens, young adults, and their families across 32 states, including the District of Columbia, and seven tribal organizations; established more than 3400 partnerships; and trained more than 7500 professionals. Expectant and parenting teens and young adults who participated in the PAF program stay in high school, make plans to attend college, and have low rates of repeat pregnancy within a year. CONCLUSIONS: Expectant and parenting teens and young adults in the PAF program demonstrated success in meeting their educational goals and preventing repeat unintended pregnancies. In addition, the staff who implemented the PAF programs learned many lessons for how to enhance programs and services to have the best outcomes for expectant and parenting young families, including creating partnerships to meet the multifaceted needs of teen parents and using evidence-based programs to promote program sustainability.

The effect of social assistance on kin relationships: evidence from Roma communities.

This paper discusses the effects of social assistance on kinship relationships in Roma, a disadvantaged European minority population, and how variation in kin support affects self-reported health and reproductive success. Data were collected in 2016-7 in several rural Roma settlements in central Serbia. The sample consisted of 143 men and 221 women. Demographic information (e.g., age, gender, educational level, marital and reproductive history, level of socioeconomic status and residence pattern), social assistance history, health status, height, and weight were collected, in addition to kinship relationship dynamics. Receiving social assistance was consistently negatively associated with all measures of kin support, more so for Roma males than females while decreased kin support was found to result in poorer self-rated health and decline in reproductive success.

Understanding the functionality of housing-related support services through mapping methods and dialogue.

This article describes the experience and process of using community mapping as a tool for collecting data on the functioning of housing-related support services in Metro Vancouver. We outline our mapping methods and discuss strengths and challenges encountered during workshops aimed at understandings how the system of housing-related supports function. Strengths were that workshops provided a forum for social participation and engagement. In addition, mapping is a research tool that enables local knowledge of service functioning and service gaps to be accessed and exchanged. Challenges include ensuring diverse representation; reducing power imbalances; and having adequate space to accommodate interested participants.

Administrative Privatization and Employment Outcomes in the Implementation of Temporary Assistance to Needy Families.

BACKGROUND: Welfare reform in the 1990s encouraged states and localities to contract out cash assistance services to for-profit and nonprofit firms operating within the private sector. Although privatized welfare delivery was heralded in the wake of Temporary Assistance to Needy Families (TANF), scant empirical research evaluates welfare privatization and its potential relationship with administrative quality and program outcomes. OBJECTIVES: This study examines the relationship between administrative privatization and TANF program outcomes, including work participation activities, unsubsidized employment, employment closure, and monthly earnings, across a large sample of individual welfare clients in the state of Florida. RESULTS: The results of methodologically appropriate hierarchical linear models demonstrate that ownership variables seldom enhance the quality of TANF outcomes, suggesting that privatization alone is not an administrative panacea in human support services. Although direct privatization effects are often found to be substantively small and inconsistent in terms of service quality improvement, in closed-case models, there is evidence that nonprofit welfare delivery is associated with superior TANF employment closure outcomes.

Home for now: A mixed-methods evaluation of a short-term housing support program for homeless families.

The use of short-term rental subsidy vouchers offers a new approach to addressing the housing needs of families facing homelessness. In Massachusetts, the Family Home pilot program placed homeless families in housing instead of shelter, providing two years of rental subsidy plus support services with the goal of enabling families to maintain market rate housing. This mixed-method case study complements staff and participant interview data with participant survey and administrative data to evaluate the implementation and short-term outcomes of Family Home in one region. Data point to improved family well-being in housing but also persistent barriers to achieving longer-term housing and economic stability. Of the families who had exited the program at the end of the study, one quarter were able to retain their housing at market rate, only 9% returned to shelter, and one in five moved in with families/friends. Lack of affordable housing in a high rental cost region and jobs that pay living wages were among the major reasons that families struggled to maintain housing. This research points to the need for integrating supportive services from the program's start, including targeted workforce development, to plan for the end of the short-term rental subsidy.

Perceived profitability and well-being in Australian dryland farmers and irrigators.

OBJECTIVE: To describe the relationship between self-reported farm profitability and farmer well-being, and to explore potential implications for farmer assistance policy. DESIGN: Cross-sectional analysis of farmers from Regional Wellbeing Survey data (wave 1, 2013) and comparison between groups. PARTICIPANTS: Participants were 1172 dryland farmers (35% women) and 707 irrigators (24% women). MAIN OUTCOME MEASURE: The Personal Wellbeing Index and the Kessler 10-item measure of general psychological distress. RESULTS: There is a consistent and significant relationship between higher profitability, greater well-being and less distress among dryland farmers and irrigators. CONCLUSIONS: The relationship between farm profitability and the well-being of Australian dryland farmers and irrigators has the potential to inform farmer assistance policy. Assistance programs can be more effective if they explicitly incorporate a profitability assessment into their targeting and eligibility requirements and a well-being component into program design and delivery. SETTING: Rural Australia. INTERVENTION: Not applicable.

The impact of failed housing policy on the public behavioral health system.

The author describes the crisis in affordable housing for individuals with serious mental illness who have extremely low incomes and outlines implications for the behavioral health system. Studies have shown that nowhere in the United States can an individual with serious mental illness who is receiving Supplemental Security Income afford housing. This has contributed to compliance issues with the Americans With Disabilities Act. The failure of housing policy to effectively address the needs of individuals with serious mental illness who are in poverty is largely to blame for the most visible and costly failures attributed to the behavioral health system: institutionalization, incarceration, and chronic homelessness. It is critical for the behavioral health field to advocate for housing policies to address the housing affordability crisis.

Addressing chronic disease within supportive housing programs.

BACKGROUND: Tenants of supportive housing have a high burden of chronic health conditions. OBJECTIVES: To examine the feasibility of developing a tenant-involved health promotion initiative within a "housing first" agency using a community-based participatory research (CBPR) framework. METHODS: Qualitative analyses of nine research capacity-building group meetings and fifteen individual pre- and post-interviews with those who completed a chronic disease self-management program, resulting in the development of several themes. RESULTS: Tenants of supportive housing successfully partnered with health care providers to implement a chronic disease self-management program, noting that "health care becomes 'relevant' with housing." CONCLUSIONS: Supportive housing organizations are well-situated to implement health promotion initiatives. Such publicly subsidized housing that is accompanied by comprehensive supports must also include self-management training to help people overcome both internal and external barriers to addressing chronic health needs.

Women's experiences in a community-based participatory research randomized controlled trial.

Integrating community-based participatory research (CBPR) into traditional study designs can enhance outcomes in studies with disadvantaged groups. Little is known, however, about study participants' experiences with these approaches, the underlying processes involved in creating more positive outcomes, and whether undesirable effects on study outcomes occur simultaneously. We conducted focus group interviews with 31 disadvantaged women who participated in a CBPR-driven randomized controlled trial (RCT) both to explore their study experiences and to obtain their interpretations of select study findings. Using dimensional analysis, we found the tailored health questionnaire, treatment by study staff members, and RCT participants' understandings of and responses to randomization were salient to what women described as transformative experiences that occurred over the course of the RCT. These findings have implications for understanding how CBPR and non-CBPR aspects of interventions and study designs have the potential to affect both process and endpoint study outcomes.

Electronic access to food and cash benefits.

The authors' purpose was to examine access to Family Independence Program and Food benefits in relation to customer service and an automated helpline. In addition, participants identified impediments and limitations to the receipt of services. Two hundred forty-four surveys were mailed to recipients of over-the-counter electronic benefit transfer cards; 58 were returned. The findings indicate that when customers (age 21-92) received assistance navigating the electronic benefits transfer system from local office staff, they were able to obtain benefits successfully. Negative credit/debit card history and touchtone phones were related to difficulty using the system. The results suggest that the local office and the contracted service provider (automatic helpline) need to provide assistance that promotes greater autonomy for the customer to make successful transitions to benefits that are delivered electronically.

State systems Advance Planning Document (APD) process. Final rule.

The Advance Planning Document (APD) process governs the procedure by which States obtain approval for Federal financial participation in the cost of acquiring automated data processing equipment and services. This final rule reduces the submission requirements for lower-risk information technology (IT) projects and procurements and increases oversight over higher-risk IT projects and procurements by making technical changes, conforming changes and substantive revisions in the documentation required to be submitted by States, counties, and territories for approval of their Information Technology plans and acquisition documents.

Targeting vulnerability after the 2005 earthquake: Pakistan's livelihood support cash grants programme.

The 7.6 magnitude (Richter scale) earthquake that struck northern Pakistan on 8 October 2005 was devastating. This paper gauges success in targeting vulnerable families during the transition from relief to reconstruction through cash assistance provided by the Livelihood Support Cash Grants (LSCG) programme. Families without a male member, with a disabled male member aged between 18 and 60 years or with more than five children, defined as vulnerable, were provided with USD 50 per month for six months via a bank transfer. The LSCG scheme enrolled around 750,000 families and selected 267,402 vulnerable families to whom it disbursed a total of USD 86.95 million. Using a community-based survey, this paper assesses leakage and under-coverage (exclusion). Approximately 30 per cent of families received the cash grant. However, only one in two was eligible for the benefit, and one in two deserving families was excluded. This is a matter of grave concern.

Does the U.S. Food Stamp Program contribute to adult weight gain?

Obesity poses substantial costs both to the individual and society, mainly through its impact on health and labor productivity. Because obesity is more prevalent among the poor some have raised concerns that food assistance programs may encourage excess weight. This paper investigates whether the U.S. Food Stamp Program contributes to adult participants' weight as measured by body mass index (BMI). Results suggest that the typical female food stamp participant's BMI is indeed more than 1 unit higher than someone with the same socioeconomic characteristics who is not in the program. For the average American woman, who is 5 ft 4 in. (1.63 m) tall, this means an increase in weight of 5.8 pounds (2.6 kg). While this association does not prove that the Food Stamp Program causes weight gain, it does suggest that program changes to encourage the consumption of high-nutrient, low-calorie foods should be considered.

Older people's experience of proactive welfare rights advice: qualitative study of a South Asian community.

OBJECTIVES: Many older people in the UK require means-tested and health-related benefits to supplement low incomes in retirement and pay for additional resources required to cope with ill-health. Ethnic minority older people have lower uptake of welfare services than white older people. This study investigated routes to the service, barriers to claiming and explored the impact of additional financial resources among ethnic minority elders by evaluating a novel welfare rights advice service which facilitated access to state benefit entitlements. DESIGN: Qualitative study using data from one-to-one interviews with ethnic minority elders from Newcastle upon Tyne, UK analysed using the Framework method. Participants were recruited to this study from among ethnic minority elders attending a full benefits assessment offered by Newcastle Welfare Rights Service. RESULTS: Twenty-two South Asian participants aged between 50 and 81 were interviewed. Nineteen participants were above state retirement age, 15 of whom were on means-tested state benefits. Knowledge of state entitlements was extremely low. Sixteen qualified for non-means-tested health benefits; six qualified for further means-tested state benefits. Additional resources had a considerable impact on participants and their families. Participants could better afford essential items such as food, bills, shoes, clothes and 'one off' payments. Less stress, increased independence and better quality of life were reported. Welfare rights advice also had a positive impact on carers, none of whom knew what they or their relatives were entitled to. CONCLUSIONS: As with older people of all backgrounds, facilitating access to state benefit entitlements with appropriate services is an important way of increasing the resources of ethnic minority older people on low incomes and/or in poor health. Such services can also significantly improve quality of life for carers. As the numbers of ethnic minority older people will rise over the next few decades, it is necessary to meet this need with linguistically and culturally appropriate welfare rights services. To do otherwise will exacerbate existing income and health inequalities.

Nutritional quality and price of university food bank hampers.

PURPOSE: Food insecurity appears to be a growing problem for post-secondary students, but little study has been made of the 51 campus-based food banks that exist. In 2003-04, the University of Alberta Campus Food Bank (CFB) distributed hampers intended to supply four days of food to 630 unique clients, of whom 207 (32.8%) were children. The nutritional adequacy of food hampers and cost saving to students were evaluated in the current study. METHODS: Hampers prepared for one adult, and for one adult with one child, were nutritionally evaluated and scored for number of servings according to Canada's Food Guide to Healthy Eating. Two types of hampers were evaluated: those containing only non-perishable items, and those containing non-perishable and perishable items. Hamper contents were priced to establish the cost saving to students. RESULTS: The study revealed that a student with one child would receive up to 58.02 Canadian dollars worth of food in a hamper that contained perishable items. All hampers met the recommended minimum servings for each food group, but were very low in fat and protein from animal sources. CONCLUSIONS: Because students can obtain hampers only twice each month, the CFB is not the solution to food insecurity on campus. Awareness of the issue of post-secondary student food insecurity needs to be raised.

Vitamins A and C, calcium, fruit, and dairy products are limited in food pantries.

Food pantries serve over 19 million Americans, yet little is known about the nutritional quality of foods distributed in pantry bags. Foods in bags from 133 clients from 19 pantry sites were itemized, and a mean site value for nutrient and food group content was calculated. If an individual consumed the pantry foods according to the Food Guide Pyramid, the bag would contain sufficient bread group foods to last approximately 7 days; vegetable and meat/protein group foods would last about 5 days, and fruit and milk group foods would last only approximately 3 days. Foods distributed were of adequate or high nutrient density for protein, fiber, iron, and folate, but were of low nutrient density for calcium, vitamin A, and vitamin C. Creative efforts are needed for pantries to procure, store, and distribute additional fruit, dairy products, and other sources of vitamins A and C and calcium.

Drug consumption facilities: an update since 2000.

The topic of drug consumption facilities or rooms (DCRs) was reviewed by Dolan, Kimber and others in Harm Reduction Digest 10, published in the September 2000 issue of DAR. As one of the first English language papers on the topic this paper has been cited extensively. Now, 3 years on, these authors and have brought together an international team of experts to revisit the topic. In this update they: (i) highlight where DCRs are operating or under consideration, (ii) review briefly new literature and (iii) discuss future directions. This Digest is a 'must read' for policy makers, advocates and practitioners in the drug field.

Everyone is still on welfare: the role of redistribution in social policy.

Most people have an inaccurate assessment of who is "on welfare." Two decades have passed since Social Work published the original version of this article, which applied Titmuss's framework of a three-tiered social welfare system and showed that nearly "everyone is on welfare." Based on new data and a more in-depth analysis, this article re-examines who benefits from and who pays for social, fiscal, and corporate welfare and concludes that all three welfare systems continue to serve and to favor the middle class, wealthy households, and large corporations. Social workers can work to transform the system from one that rewards power and privilege to one that ensures distributive justice for all.

Use of consumer ratings for quality improvement in behavioral health insurance plans.

BACKGROUND: The Consumer Assessment of Behavioral Healthcare Services (CABHS) survey collects consumers' reports about their health care plans and treatment. The use of the CABHS to identify opportunities for improvement, with specific attention to how organizations have used the survey information for quality improvement, is described. METHODS: In 1998 and 1999, data were collected from five groups of adult patients in commercial health plans and five groups of adult patients in public assistance health plans with services received through four organizations (one of three managed behavioral health care organizations or a health system). Patients who received behavioral health care services during the previous year were mailed the CABHS survey. Non-respondents were contacted by telephone to complete the survey. RESULTS: Response rates ranged from 49% to 65% for commercial patient groups and from 36% to 51% for public assistance patients. Promptly getting treatment from clinicians and aspects of care most influenced by health plan policies and operations, such as access to treatment and plan administrative services, received the least positive responses, whereas questions about communication received the most positive responses. In addition, questions about access- and plan-related aspects of quality showed the most interplan variability. Three of the organizations in this study focused quality improvement efforts on access to treatment. DISCUSSION: Surveys such as the CABHS can identify aspects of the plan and treatment that are improvement priorities. Use of these data is likely to extend beyond the behavioral health plan to consumers, purchasers, regulators, and policymakers, particularly because the National Committee for Quality Assurance is encouraging behavioral health plans to use a similar survey for accreditation purposes.