Exploring the Impact of COVID-19 Pandemic on Economic Activities and Well-being of Older Adults in South-eastern Nigeria: Lessons for Gerontological Social Workers.

The novel COVID-19 pandemic and its containment measures such as lockdown and physical distancing are remarkedly affecting older adults' economic activities and well-being in ways deserving of urgent attention. To strengthen caregiving and promote targeted care for older adults during and after the pandemic, this paper investigates the impact of the coronavirus on the economic activities and well-being of older adults in Enugu and Anambra states, Nigeria. Hermeneutic phenomenology was adopted and 16 older adults aged between 60 and 81 years, with a majority of them still working as farmers and traders were phone-interviewed. Findings highlighted four key lessons for gerontological social workers including 1) the fear that impact of the containment measures could kill the older adults faster than the virus; 2) the measures generate a feeling of neglect and marginalization of healthcare needs among older adults; 3) altered positive health-seeking behavior among the older adults; 4) and concern about the absence of functional policy and plan to address the welfare of older adults. Therefore, the central focus of the gerontological social workers and Nigerian polity should not be on how to reduce the spread of the disease alone, but on an application of caution in instituting and implementing the measures.

Special Issues in Immigrant Medicine.

Immigrants enrich the United States through economic contributions and unique perspectives. Immigrants find themselves navigating a new culture, a complicated health care system, unfamiliar social programs, and an ever-changing policy environment. They may be discouraged by unmet expectations of life in the United States, changing family dynamics, and discrimination. Screening for the social determinants of health is crucial, as not all patients will proactively seek the advice of their health care provider for these issues. Health care providers can assist and empower immigrants to navigate these challenges, as well as serve as advocates on a broader scale.

Scaling Up Housing Services Within the Child Welfare System: Policy Insights From Simulation Modeling.

OBJECTIVES: Housing insecurity and homelessness contribute to risk of maltreatment among one in five of the nearly 3.5 million children annually investigated for maltreatment in the United States. The Family Unification Program (FUP)-a federal initiative-connects inadequately housed families involved in child welfare with long-term rental subsidies to avoid foster placement. However, FUP remains understudied and underutilized with funding levels that serve only a fraction of eligible households. The present study uses system dynamics modeling to inform decision-making by testing policies for scaling FUP. METHOD: Simulations model delivery of FUP within child welfare from a feedback perspective. Calibrated on national data, models replicate trends in child welfare involvement from 2013 through 2016, and analyses forecast rates through 2019. Experiments test policies that enhance FUP. Outcomes track system-wide rates of family separation and returns on investment of expanded housing interventions. RESULTS: Dramatic expansions of FUP benefit more families and improve marginal return on investment. Yet, scale-up fails to reduce system-wide rates of family separation or generates substantial cost-savings. CONCLUSIONS: Simulations demonstrate structural challenges for scaling FUP. Constant demand for affordable housing constrains sustainable improvements in child protection. Child welfare responses to homelessness require innovations that reduce demand for housing services through prevention and earlier intervention.

Equity in aid allocation and distribution: A qualitative study of key stakeholders in Northern Uganda.

The Sustainable Development Goals have spurred a growing interest in and focus on equitable development. In theory, donors can play an important role in promoting equity within a country by providing services, influencing government policies and incorporating equity into decision-making. However, we know little about whether this actually happens on the ground. We conduct what we believe is the first study to explore the extent to which equity is prioritised in the allocation and distribution of aid, based on in-depth interviews with government officials, bilateral and international donors, and implementing partners operating in Northern Uganda. We find that a broad category of people are perceived to be marginalised/vulnerable, with a substantial segment largely untargeted by major donor programmes. Various stakeholders employ a wide range of strategies to identify the most vulnerable individuals and groups, including the use of available data and statistics, consultation and engagement with relevant stakeholders, and undertaking primary data collection. The strategies used to incorporate equity in aid allocation and distribution include: targeting the regions of Northern Uganda and Karamoja in particular, targeting both refugees and host populations in refugee-hosting districts, prioritising the critically vulnerable in any aid distribution process, and using specific tools and consultants to ensure that major equity issues are addressed in proposals. Challenges undermining the process include poor understanding of the concept of equity among some implementing partners, lack of comprehensively disaggregated data, corruption, and political interference in choice of aid location from government officials and donors.

Acceptability of an economic support component to reduce early pregnancy and school dropout in Zambia: a qualitative case study.

Background: Cash Transfer (CT) schemes have become popular poverty reducing measures in many low and middle-income countries. Research indicates that when provided to girls in resource poor settings, cash transfers can increase education and postpone marriage and pregnancy. However, a few studies indicate that they can also have negative effects which can affect their acceptability, such as generating intra-community tensions.Objective: Conceptually informed by Rogers' diffusion of innovation theory, this paper explores factors affecting the acceptability of economic support in a randomized controlled trial in rural Monze and Pemba Districts of Southern Province in Zambia.Methods: Qualitative data were collected through five focus group discussions and six in-depth, semi-structured interviews and analysed using thematic analysis. This study was done in the combined arm of a trial where girls received both economic support and participated in youth clubs offering sexuality and life-skills education.Results: In the study communities, acceptability was encouraging by the belief that economic support provided benefits beyond beneficiaries and that it improved access to education, and reduced teen pregnancies, marriages and school drop-out. However, provision of economic support only to selected girls and their parents and fear among some that the support was linked to satanic practices negatively affected acceptability. These fears were mitigated through community sensitisations.Conclusion: The study demonstrated that relative advantage, observability, simplicity and compatibility were key factors in influencing acceptability of the economic support. However, to enhance acceptability of cash transfer schemes aimed at addressing early marriage and pregnancy, it is important to explore socio-cultural factors that create suspicions and negative perceptions and to provide schemes that are perceived as relatively better than available similar schemes, understood, compatible and viable beyond the immediate beneficiary.

Alternatives to SNAP: Global Approaches to Addressing Childhood Poverty and Food Insecurity.

The Supplemental Nutrition Assistance Program (SNAP) in the United States is a key element of the nation's safety net. Yet, 12.5 million US children live in households that experience food insecurity, despite national spending of $65 billion on SNAP alone.In analyses integrating data from the 36 Organisation for Economic Co-operation and Development (OECD) countries, we found that child poverty and food insecurity are much higher in the United States than in most of the other OECD countries. The United States has higher total social spending than other OECD countries, but a lower rate of spending on children and families. This international comparison suggests that potentially effective solutions implemented in other countries might help further alleviate US childhood poverty and food insecurity.Broadly, we recommend increasing investments in families with children, particularly low-income families. Our specific recommendations include increasing SNAP benefits, establishing additional benefits to support low-income families with young children, and implementing a universal child allowance. Achieving substantial reductions in child poverty and food insecurity will require overcoming many challenges, including the current US political climate, a national history of underinvestment in social programs, a lack of political will, and a culture of structural racism.

Solving Homelessness from a Complex Systems Perspective: Insights for Prevention Responses.

Homelessness represents an enduring public health threat facing communities across the developed world. Children, families, and marginalized adults face life course implications of housing insecurity, while communities struggle to address the extensive array of needs within heterogeneous homeless populations. Trends in homelessness remain stubbornly high despite policy initiatives to end homelessness. A complex systems perspective provides insights into the dynamics underlying coordinated responses to homelessness. A constant demand for housing assistance strains service delivery, while prevention efforts remain inconsistently implemented in most countries. Feedback processes challenge efficient service delivery. A system dynamics model tests assumptions of policy interventions for ending homelessness. Simulations suggest that prevention provides a leverage point within the system; small efficiencies in keeping people housed yield disproportionately large reductions in homelessness. A need exists for policies that ensure reliable delivery of coordinated prevention efforts. A complex systems approach identifies capacities and constraints for sustainably solving homelessness.

Breastfeeding Discontinuation Not Associated with Maternal Pregravid BMI But Associated with Native Hawaiian or Other Pacific Islander Race in Hawaii and Puerto Rico WIC Participants.

Objectives This study investigated the association between maternal pregravid body mass index (BMI) and breastfeeding discontinuation at 4-6 months postpartum in Hawaii and Puerto Rico participants from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods A secondary data analysis was conducted from a text message-based intervention in WIC participants in Hawaii and Puerto Rico. The analysis included 87 women from the control group who initiated breastfeeding and whose breastfeeding status was known at the end of the study when infants were 4-6 months old. Pregravid BMI and breastfeeding discontinuation were assessed using questionnaires. Results The association between pregravid BMI and breastfeeding discontinuation was not significant in the unadjusted model or in the adjusted model. Native Hawaiian or Other Pacific Islander (NHOPI) participants showed significantly increased odds of discontinuing breastfeeding (adjusted odds ratio [AOR] 7.12; 95% CI 1.34, 37.97; p = .02) compared to all the other racial/ethnic participants, as did older women ages 32-39 years versus women who were 25-31 years old (AOR 4.21; 95% CI 1.13, 15.72; p = .03). Women who took vitamins while breastfeeding had decreased odds of discontinuing breastfeeding (AOR 0.15; 95% CI 0.05, 0.46; p = .0009). Conclusions for Practice Pregravid BMI was not significantly associated with breastfeeding discontinuation at 4-6 months postpartum in women from Hawaii and Puerto Rico WIC, but NHOPIs and women who were older had higher odds of discontinuing breastfeeding. The results of this study may inform strategies for breastfeeding promotion and childhood obesity prevention but should be further investigated in larger studies. ClinicalTrials.gov Identifier: NCT02903186.

Resisting austerity measures to social policies: multiple explanatory case studies.

Since Margaret Thatcher reached power in the United Kingdom, European governments have increasingly turned to neoliberal forms of policy-making, focusing, especially after the 2008 Great Recession on 'austerity policies' rather than investing in social protection policies. We applied a multiple explanatory case studies methodology to examine how and why challenges and resistance to these austerity measures are successful or not in four settings for three different social policy issues: using a gender lens in state budgeting in Andalusia (Spain), maintaining unemployment benefits in Italy and cuts to fuel poverty reduction programs in Northern Ireland and England. In particular, we intended to learn about whether resistance strategies are shared across disparate cases or whether there are unique activities that lead to successful resistance to austerity policies. As our approach drew from realist philosophy of science, we started with initial theories concerning collective action, political ideology and political power of affected populations. Our findings suggest that there are similarities between the cases we studied despite differences in political and policy contexts. We found that joint action between advocacy groups was effective in resisting cuts to social spending. Evidence also indicates that the social construction of target populations is important in resisting changes to social programmes. This was observed in both England and Northern Ireland where pensioners held significant political clout.

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.

Can a conditional cash transfer reduce teen fertility? The case of Brazil's Bolsa Familia.

In 2008, Brazil's conditional cash transfer program expanded to cover a wider range of ages. Poor families are now given stipends for their children's school attendance up to age seventeen, whereas prior the maximum age was fifteen. Using a nationally representative household survey, we estimate the impact of this policy on teen fertility with a triple difference analysis on the fertility outcomes of treated cohorts vs. non-treated cohorts based on income eligibility, age eligibility, and timing of program implementation. We find a three percentage point drop in fertility among eligible teens within five years of program implementation. This offsets the difference in fertility between poor and non-poor teens. The impact is concentrated in urban areas, with no program effects found in rural areas. We are able to replicate these findings using National Birth Registry Data.

Information technology as a tool for the Italian Institute of Social Security (INPS) in the management of social security and civil disability: Pro and cons.

We examine, from a medical-legal perspective, the pro and cons of the information technology procedures that the Italian Institute of Social Security (INPS) has implemented to manage the provision of social disability assistance, meaning that separate from the payment of pension contributions, being welfare, anchored to an administrative requirement by way of the compulsory payment of a minimum social security contribution.

Disability income support design and mental illnesses: a review of Australia and Ontario.

AIM: Mental illnesses have many distinctive features that make determining eligibility for disability income support challenging - for example, their fluctuating nature, invisibility and lack of diagnostic clarity. How do policy makers deal with these features when designing disability income support? More specifically, how do mental illnesses come to be considered eligible disabilities, what tools are used to assess mental illnesses for eligibility, what challenges exist in this process, and what approaches are used to address these challenges? We aimed to determine what evidence is available to policy makers in Australia and Ontario, Canada, to answer these questions. METHODS: Ten electronic databases and grey literature in both jurisdictions were searched using key words, including disability income support, disability pension, mental illness, mental disability, addiction, depression and schizophrenia, for articles published between 1991 and June 2013. This yielded 1341 articles, of which 20 met the inclusion criteria and were critically appraised. RESULTS: Limited evidence is available on disability income support design and mental illnesses in the Australian and Ontarian settings. Most of the evidence is from the grey literature and draws on case law. Many documents reviewed argued that current policy in Australia and Ontario is frequently based on negative assumptions about mental illnesses rather than evidence (either peer reviewed or in the grey literature). Problems relating to mental illnesses largely relate to interpretation of the definition of mental illness rather than the definition itself. CONCLUSIONS: The review confirmed that mental illnesses present many challenges when designing disability income support and that academic as well as grey literature, especially case law, provides insight into these challenges. More research is needed to address these challenges, and more evidence could lead to policies for those with mental illnesses that are well informed and do not reinforce societal prejudices.

Understanding the linkages between social safety nets and childhood violence: a review of the evidence from low- and middle-income countries.

As many as one billion children experience violence every year, and household- and community-level poverty are among the risk factors for child protection violations. Social safety nets (SSNs) are a main policy tool to address poverty and vulnerability, and there is substantial evidence demonstrating positive effects on children's health and human capital. This paper reviews evidence and develops a framework to understand linkages between non-contributory SSNs and the experience of childhood emotional, physical and sexual violence in low- and middle-income countries. We catalogue 14 rigorous impact evaluations, 11 of which are completed, analysing 57 unique impacts on diverse violence indicators. Among these impacts, approximately one in five represent statistically significant protective effects on childhood violence. Promising evidence relates to sexual violence among female adolescents in Africa, while there is less clear evidence of significant impacts in other parts of the developing world, and on young child measures, including violent discipline. Further, few studies are set up to meaningfully unpack mechanisms between SSNs and childhood violence; however, those most commonly hypothesized operate at the household level (through increases in economic security and reductions in poverty-related stress), the interpersonal level (improved parental behaviours, caregiving practices, improved psychosocial well-being) and at the child-level (protective education and decreases in problem or risky behaviours). It is important to emphasize that traditional SSNs are never designed with violence prevention as primary objectives, and thus should not be considered as standalone interventions to reduce risks for childhood violence. However, SSNs, particularly within integrated protection systems, appear to have potential to reduce violence risk. Linkages between SSNs and childhood violence are understudied, and investments should be made to close this evidence gap.