the impact of welfare reform on two communities in new
TRANSCRIPT
The Impact of
Welfare Reform on Two Communities in
New York City New York State Scholar Practitioner Team CUNY Graduate Center PhD Program in Anthropology ©2002
The Impact of Welfare Reform on Two Communities in New York City
A report of Research Findings From
The Scholar Practitioner Program of the Devolution Initiative The W.K. Kellogg Foundation
Dana-Ain Davis, MPH, Ph.D. Purchase College, State University of New York
and Ana Aparicio Graduate Center, City University of New York Audrey Jacobs Consultant Akemi Kochiyama Graduate Center, City University of New York Andrea Queeley Graduate Center, City University of New York Beverly Yuen Thompson New School for Social Research Leith Mullings, Ph.D. Graduate Center, City University of New York
The Scholar Practitioner Program
Department of Anthropology, Graduate Center City University of New York
October 2002
COVER Community members and employees of community-based organizations
working with the New York State Scholar Practitioner team took the photographs on the cover of this report. The photos are part of photovoice which is a participatory action research strategy. Through photovoice people capture their community on film, reflecting the issues confronting their environment. Photovoice has three main goals: to enable people to record and reflect their community’s strengths and concerns; to promote critical dialogue and knowledge about personal and community issues through large and small group discussions of photographs; and to reach policy makers.1 The flexibility, innovation and emphasis on participation that characterize this methodology made it an ideal strategy for the New York State Scholar Practitioner team to use in our research examining the impact of welfare reform on residents living in Central and East Harlem and the Lower East Side. Below are the explanations that the photographers gave to describe the photos. The captions should be read counterclockwise.
1. ”There are more people going to work. You don’t see anybody in the
neighborhood. There used to be crowded streets on a sunny day with children playing and people hanging outside. Now, the streets are empty.
-Yvonne, Harlem
2. “These children are on the sidewalk in front of a local gallery, Mixta. They’re painting on the sidewalk with material someone from the gallery gave them. Here’s a gallery; it serves certain purposes for the community. On the negative side, this is where the children play. This is the space-locked in gates, playing on concrete. -Young woman, East Harlem
3. ”People can’t afford to buy quality food from the supermarket. So they buy oil and rice off a truck at cheap prices. But this stuff is not healthy. This oil is for cooking, it’s cheaper and lasts longer but sometimes it’s rancid. They get it from the Africans.” -Janette, Harlem
4. “There is a Mexican lady on 116th Street. It’s good food on the street; it’s good all the way around. I’d rather have fritura on the street than fritura
1 Caroline C. Wang. 1999. Photovoice: A Participatory Action Research Strategy Applied to Women’s Health. Journal of Women’s Health, 8(20)185-192
from Burger King. She’s providing food people want to eat, what they’re familiar with. She’s probably undocumented and she found a way to make money. It’s tragic though, it’s really difficult for her. She’s busting her butt trying to make a buck. She’s working independent but what she’s doing is difficult.” -East Harlem Resident
5. “On 104th between 2nd and 3rd Ave., the street is full of clothes on both sides. The homeless sell clothes…we call it Bloomingdales. It’s been happening 2 or 3 years. They have good stuff… shoes, hats, picture frames… some stolen, some junk. They sell it for a dollar or two. About every two weeks, these garbage men come and clean up the street…but within a couple of hours, people have their stuff set up again.” - Nancy, Union Settlement worker, East Harlem
6. ”This is on 106th Street- the Graffiti Hall of Fame… it’s the idea of having art outside and people reclaiming space for everyone to see.” -Resident, East Harlem
7. Flower cart in East Harlem 8. “Community gardens are great. People learn, if they don’t already know,
how to plant. They can get food in these places. It ‘s also a beautiful place to hang out.” -Resident, East Harlem
9. “This is a botanica. It’s about the keeping of spiritual traditions and it’s a moneymaking thing- they can fool people. They also help with the combination of something physical and mental, depending on which botanica you go to. Someone sees about your emotional well-being also.”
-Resident, East Harlem
10. “At the FDR, there used to be people living under there. There were no gates…. We’d call it a ‘shanty town’. People lived in these airplane cargo containers and there used to be a whole lot more containers here. See, there’s still someone in this one.” -Shawn, Lower East Side Resident
11. “They’re going to the park. There are so many kids. For me, that’s a big class for kindergarten. Kindergarten and pre-K classes have grown because more women have to go to work. We’re going to need more schools, more teachers… then there are young girls coming up pregnant. They’ve opened up more programs and classes and there are more kids in the classrooms. -Shawn, Lower East Side
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PREFACE This Community Outreach and Research Project report was prepared under the auspices of The New York State Team of the Scholar Practitioner Program. The Scholar Practitioner Program is part of the Devolution Initiative, a project funded by the W.K.Kellogg Foundation since 1996.
In 1996 the W.K. Kellogg Foundation embarked upon a multi-year initiative geared toward understanding the effects of welfare reform and health care in five states across the country: Wisconsin, Florida, Washington, Mississippi, and New York. In 1999 the Kellogg Foundation added the Scholar Practitioner Program as part of its effort to include the expertise of university-based researchers and community practitioners in the Devolution Initiative. The Community Outreach and Research Project is a project of the New York State Scholar Practitioner Program.
Under the guidance of Dr. Leith Mullings, The New York State Scholar Practitioners worked in consultation with three New York State Devolution grantees: Children’s Defense Fund –NY, Citizen Action of New York and Citizens’ Committee for Children. One of the research aims was to understand the ways in which residents living in Harlem and in the Lower East Side of New York have been affected by welfare reform.
A great deal of literature exists on welfare reform and its implementation in various states.2 This report focuses on two specific areas of New York City. The report documents the experiences and perceptions of men and women who receive public assistance and who live in Harlem or the Lower East Side. The report seeks to present a perspective on the effect of welfare reform policy in low-income communities where the residents include people of color.
2 See, for example Assessing the New Federalism, The Urban Institute. http://newfederalism.urban.org
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ACKNOWLEDGEMENTS
The New York State Scholar Practitioner Team would like to thank all the
people who shared their personal experiences as well as those who helped put us in contact with them. At Union Settlement, we thank Ellen Perlman Simon, Executive Director; Maria Quiroga and the Adult Education program; Ms. Glover, Rosemarie Obiapi, and Nancy Jimenez at the Leggett Childcare Center; and Armando Hernandez of the Adult Education program. We appreciate the efforts of Karen Owes and the Maternal Infant and Reproductive Health Program. At Harlem Congregations for Community Improvement we thank Yvonne Giordano, Wayne Francis and Paul Dunn. At the Lower East Side Family Union, we would like to thank Ralph Dumont and Darryl Chisholm. We would like to thank Terri Wright, Program Officer at the Kellogg Foundation and Dr. Ronald Walters, Director of the Scholar Practitioner Program.
For her assistance in developing the questionnaire and analyzing the data,
we thank Ramona Ortega at Urban Justice Institute. The New York State Scholar Practitioner Team is grateful to Mimi Abramovitz, D.S.W, of Hunter College School of Social Work; John Martinez of Manpower Demonstration Research Corporation, and Ana Motta-Moss, Senior Researcher with the Environmental Psychology Department at the Graduate Center, City University of New York. They each reviewed the report and made critical suggestions in their reviews of the report. Finally we thank Carol Meyers and Sayida Self for their editorial work on this report.
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TABLE OF CONTENTS Cover i Preface iii Acknowledgements iv Executive Summary 1 PART I - OVERVIEW 11 1. Introduction 12
Welfare Reform The W.K. Kellogg Devolution Initiative The Community Outreach and Research Project
2. Data Collection 15
Focus Group Methodology Recruitment Strategies
Data Analysis of Focus Groups Demographic Summary of Focus Group Participants Survey Methodology Demographic Summary of Survey Respondents Limitations of Data
PART II - FINDINGS 28 3. Training and Work Experience Programs 29
The Desire for Education Restricted Opportunity Conflict with Non-WEP Workers Skills Mismatch Unemployment
4. Childcare Issues 39
Childcare and Work Childcare Vouchers/Assistance
5. Sanctions, Benefit Reductions and Case Closures 43
Sanctions Discovering the Loss of Benefits
6. “ Without Health There is No Work:” Adult Health Care 48
Issues Access to Insurance and Health Care Discordant Health Coverage
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Immigrant Health Care Needs Strategies for Dealing with Lack of Health Care Coverage
or Under-insurance 7. Child Heath Care Issues 53
Adequacy of Health Coverage Measures of Inadequacy Parental Concerns about Children’s Health Care Strategies for Dealing with Lack of Health Care Coverage
or Under-insurance Child Health Plus
8. The Struggles of Welfare Reform: Participants’ General 60
Perceptions of and Experiences with the Welfare Reform System Caseworker Treatment Caseworker Inefficiency
9. Quality of Life under Welfare Reform 64
Food Insecurity Paying Bills Housing
Appendices 67 A. Policy Recommendations
Public Health Insurance Programs Childcare
B. New York Scholar Practitioner Team C. Community Descriptions of Harlem and the Lower East Side D. Focus Group Questions E. Informed Consent F. Focus Group Participant Summary G. Focus Group Demographic Summary Form H. Job Center Questionnaire I. Tables
1. Job Search and Work Experience Program Participation by Race/Ethnicity
2. Employment Status and Reasons for being Unemployed by Gender
3. Employment Status and Reasons for being Unemployed by Race/Ethnicity
4. Benefit Reduction and Sanctions by Race/Ethnicity
5. Benefit Reduction and Sanctions by Gender 6. Adult Insurance Coverage and Loss by Race/Ethnicity 7. Adult Insurance Coverage and Loss by Gender
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8. Adult Insurance Coverage and Loss by Site 9. Caseworker Contact by Race/Ethnicity 10. Well-being Indicators (2000-2001) by Race/Ethnicity 11.Well-being Indicators (2000-2001) by Gender
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THE IMPACT of WELFARE REFORM ON TWO COMMUNITIES IN NEW YORK CITY
EXECUTIVE SUMMARY
In 1996, President Clinton signed the Personal Responsibility and Work Opportunity Reconciliation Act, popularly known as welfare reform. Title I of this legislation replaced the Aid to Families with Dependent Children (AFDC) entitlement program with Temporary Assistance for Needy Family (TANF). TANF is a block grant from the federal government that provides states with an annual Family Assistance grant. There is a five-year lifetime limit on the receipt of TANF funds and after two years all able-bodied recipients must work full time for their benefits.
Conservative and neo-liberal politicians have lauded the success of welfare reform for decreasing the welfare rolls in the media. However, recent scholarship has pointed to the disproportionate impact of welfare reform policy on communities of color.3 Economic vulnerabilities due to race and ethnicity have long been one aspect of poverty. The racial imbalance of who constitutes the poor has been accentuated by welfare reform policy, as immigrants, Latina, African American and Asian women absorb the punitive aspects of welfare reform. To address these issues, the New York State Scholar Practitioner Team sponsored by the W.K. Kellogg Foundation’s Devolution Initiative developed the Community Outreach and Research Project. This project was organized in concert with three other New York State Devolution Initiative grantees: The Children’s Defense Fund-NY, Inc; Citizens Action of New York; and Citizens’ Committee for Children. The project also benefited from the support of the New York Immigration Coalition.
Recognizing the disparate impact of welfare reform on communities of color,4 the goals of the project were two-fold: (1) to better understand the effects of reforms in health care and welfare in Harlem and the Lower East Side; and (2) to build the capacity of disproportionately affected populations in New York City, particularly in Harlem and the Lower East Side to mobilize around issues related
3 See for example, Dana M. Davis (2001). Surviving Welfare Reform: Battered Black Women’s Strategies for Survival in Poughkeepsie, New York. Ann Arbor, MI: UMI Dissertation Services and, Linda Burnham (2001, September). Welfare Reform, Family Hardship and Women of Color. The Annals. American Academy of Political and Social Sciences. 577:38-48. 4 Ana Aparicio, Dana Davis, Audrey Jacobs, and Leith Mullings (2000). Racial and Ethnic Disparities and Welfare Reform in New York State. New York: City University of New York.
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to welfare reform. The project was particularly concerned with issues of affordable, quality and accessible health care and childcare.
The members of the New York Team of the Scholar Practitioner Program, in consultation with the other New York State grantees, developed a multi-faceted research initiative. The research team conducted six focus groups in Harlem and the Lower East Side and administered surveys to 200 people as they exited Manhattan Job Centers, the one-stop welfare centers. The team also conducted individual interviews and developed materials for distribution to community residents. Finally, they undertook a participatory research technique known as Photo Voice, in which welfare participants and the employees of community-based organizations were provided with cameras to visually capture the impact of poverty and welfare reform in their communities.
Thirty-three individuals participated in the focus groups. Most were women of
color, 86% identified themselves either as African American or Latino and 76% were between the ages of 20 and 41. Eighty-three percent had incomes below 150% of the federal poverty level for a family of two. The demographic characteristics of survey respondents were as follows: 56% were African American or Black, 32% were Latino, 7% were White, and 5% were “other”. Sixty-eight percent were under 41 years of age and 65% were single-never married. The research focused on six areas of individuals’ experience with welfare reform: training and the Work Experience Program (WEP), childcare, sanctions and benefits, adult health care, child health care, general aspects of the welfare system in general, and quality of life under welfare reform. Key findings from each of these areas are presented below. Training and Work Experience Programs (WEP)
One of the main purposes of welfare reform has been to end the dependence of needy parents on government benefits. The promotion of job preparation and making access to benefits contingent on participation in unpaid work is central to welfare reform. The New York City workfare program, known as the Work Experience Program (WEP) is especially restrictive. WEP assignments are not jobs and workers have neither benefits nor job protection. Beyond the mandated work hours, work related activities can be expanded to include job skills training related to employment or education directly related to employment. The 1996 law does not, however, permit certain college programs to be counted as work, despite the fact that studies have shown that as little as one semester of full-time, post-secondary education can raise yearly earnings by as much as $10,000. 5
5 Anthony P.Carnevale and Donna M. Desrochers. (1999). "Getting Down to Business Matching Welfare Recipients Skills to Jobs that Train": Princeton, NJ: Educational Testing Service.
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Key Findings: • WEP frequently presented an obstacle to education. Forty-two percent of
the focus group participants and 39% of survey respondents had not completed high school. Both groups indicated that welfare policy undermined their ability to go to school. Others with at least a high school degree indicated that caseworkers challenged their enrollment and attendance at vocational training and higher education institutions, forcing them into programs incongruent with their own perceived abilities.
• WEP assignments frequently did not prepare participants for nor lead to
a permanent job. Ninety-three percent of survey respondents were unable to obtain a permanent job from their WEP assignment. Both groups felt that the assignments would not help them to secure employment that would allow them to adequately care for their families. Focus group participants noted that though the jobs to which caseworkers steered them often came with a promise of full time employment, this rarely materialized.
• Training and WEP assignments did not provide skills for the existing job
market. For the most part, focus group members considered the training programs available through social services and private agencies bereft of opportunity for permanent employment. Their WEP assignments along with those of survey respondents took place primarily in the parks or in other positions in which the city has a hiring freeze.
• WEP assignments were not matched to people’s skills. Data indicated
that even individuals with long-term work experience and/or higher education were forced to take unskilled, entry-level assignments, often in the parks.
• Health related issues and the availability of jobs were cited most often
as barriers to full-time employment. Thirty-six percent of survey respondents stated that health issues prevented them from working, and 7% specifically cited their fear of losing Medicaid benefits. Thirty-four percent of survey respondents indicated that the lack of available jobs was a barrier to employment and 19% reported the absence of jobs that paid a living wage as compared to only 14% who cited the lack of job skills.
• Certain barriers were gender-specific. Women were much more likely to
mention additional barriers related to their domestic situation; they included lack of childcare (15%), pregnancy (8%) and domestic violence (9%).
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There were significant differences among racial categories concerning employment and unemployment. Whites were two times more likely to be employed than Blacks and they reported the fewest work-related barriers. However, the data points to Whites having more health issues than any other group. White women cited domestic violence, as a barrier to employment almost three times more often than did Black and Latina women. Childcare Issues
With more than one million single mothers entering the labor force since the enactment of PRWORA in 1996, the need for childcare has grown considerably. Changes in welfare have included an allotment of funds to subsidize childcare costs that are beyond the means of low-income families. The funds, however, come nowhere near to meeting the needs of New York working families. A recent study by the Citizens’ Committee for Children of New York estimates that 100,000 children between the ages of 0 and 5 are not receiving the subsidies for which they are eligible. Moreover, even when funds are available, childcare slots among formal home-based or center-based providers are insufficient, and this is especially the case for infant care or for parents seeking care during non-traditional hours. Key Findings: • Finding trustworthy childcare was of great importance to parents.
Focus group parents were hesitant to leave children with caretakers they did not know and several described harmful experiences with informal, unregulated caregivers.
• Childcare was an important barrier to employment and participation in
WEP assignments. Focus group participants cited the lack of adequate childcare as an impediment to employment. Twenty-seven percent of survey respondents with children reported they needed childcare in order to meet the work mandate, while only 22% of them had childcare in place. Fifteen percent of women and 9% of men respondents overall cited the lack of childcare as the reason they were unemployed.
• Childcare was more frequently of concern to women as compared to
men. Seven times more women survey respondents than men identified the lack of childcare as the reason they were not working.
• There were significant differences among ethnic groups concerning
childcare as a barrier to employment and vouchers. Ninety-four percent of Black survey respondents with children cited lack of childcare as an employment barrier compared to 18% of White respondents and 11% of Latino respondents.
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• Parents lack sufficient information to access childcare vouchers. Many focus group participants had no knowledge of childcare vouchers or childcare assistance, while others who knew of their existence did not know how to access the vouchers or felt the system was not effective.
• Childcare vouchers were not always available. Only 7% of the women
survey respondents said that their benefits included childcare vouchers, although 37% were in a job search program and 24% had a WEP assignment.
Sanctions and Benefits Reductions
Sanctioning, or the temporary suspension of benefits, has become the punitive measure directed at those who do not follow the work mandates or in some way fail to meet the conditions for the receipt of assistance. In some cases it is the result of missed appointments or circumstances beyond the control of the individual. Sometimes, however, welfare participants are sanctioned due to administrative error. In addition, benefits are reduced or cases are closed in relation to the increase in earned income. In either case, sanctions and benefit reductions often exacerbate economic fragility, and the swiftness with which these changes in welfare status are imposed can be very problematic. Key Findings: • Sanctioning was a prevalent experience. Fifty-five percent of focus group
participants and 35% of survey respondents had been sanctioned during the previous year. The most common cause for sanctioning and case closure was non-compliance with WEP assignments. Among survey respondents, 31% of Whites had had benefits cut compared to 56% of all other racial/ethnic groups; 31% of Whites had been sanctioned in the previous year compared to 34% of Blacks and 41% of Latinos.
• The process of benefit reductions and case closures did not make
allowances for instability in the low-wage labor market. Many of the jobs that TANF recipients were able to secure were only temporary. Nevertheless, respondents reported that cases were closed, and when people lost their job they had to reapply for benefits, a time consuming process that often deepened economic fragility.
• Participants reported discovering changes in their welfare status after
the fact. Focus group participants reported that they had not been informed prior to the closure of cases. Some participants stated that they discovered their loss of benefits when they attempted to access goods or services. Sometimes cases were closed in error and the diligence required to have the case re-opened could be daunting.
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• There were racial differences in participant reports of how they were informed of their sanctions. Among survey respondents who had been sanctioned, only 58% of Latinos and 53% of Blacks reported receiving a letter informing them of their situation compared to 75% of Whites.
Adult Health Care Issues
In 1999, 42.8% of New York’s uninsured population was 18 – 34 years of age. Thirty-four percent had an income of 100% to 200% of the poverty level. Parallels can be made between the broader New York population and those who participated in the focus groups and respondents to the survey. Issues of adult access to health care and health insurance were particularly significant. One particular issue that emerged was that of “discordant health coverage,” defined as uneven coverage among family members whereby some, but not all members of a household, are covered by insurance.
Key Findings: • Lack of health insurance was a significant problem. Thirty-six percent of
focus group participants reported that they or a child lacked insurance and 43% of survey respondents had lost health insurance benefits during the previous two years.
• There were racial disparities concerning reported loss of health
insurance. Based on self-reports, Black and Latino survey respondents were twice as likely as Whites to have lost health benefits either due to job loss or sanctions. Of Whites who had lost benefits, most indicated they had lost them due to administrative problems at the welfare office as opposed to being sanctioned.
• Health conditions differed among racial/ethnic categories. Sixty-nine
percent of Whites reported having a chronic condition compared with 51% of Latinos and 44% of Blacks. These findings in this survey contrast with studies that have examined racial differences in health outcomes. A possible explanation is the higher rate of Whites in the sample who were on SSI, 20%, compared to 5% of Blacks and 7% of Latinos.
• Usage of medical care differed by racial categories. While 39% of Whites
had sought medical treatment eight or more times in the previous year, this was true of only 33% of Latinos and only 20% of Blacks . However 18% of Blacks and 15% of Latinos had used the emergency room for their last doctor’s visit as compared to no Whites.
• Usage of medical care also differed by gender. While men had sought
medical care one to three times in the previous year at similar rates as women, women overall had gone to the hospital or to a community clinic more
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frequently than men. Women were much more likely than men to use a community-based clinic.
• Usage of insurance differed by racial/ethnic category and by gender.
While at least 50% of all racial groups paid for their last doctor visit with insurance, Latinos were more likely to do so than other racial/ethnic groups. Women were slightly more likely to be insured than men. Because women were more likely to be insured, they utilized insurance to cover the cost of medical visits more often than did men.
• Discordant health coverage usually occurred where children had
insurance coverage but parents did not. Three types of circumstances gave rise to discordant health coverage. The first was when the parent was an immigrant and the child(ren) was born in the United States. The second circumstance was when the parent lost a job and with it health coverage but was able to secure Medicaid or Child Health Plus (CHPlus) for his/her child(ren).6 The third circumstance was when the parent was sanctioned – his/her coverage ended, but the child's coverage was continued.
• Immigrants faced additional problems in accessing health care and
insurance. Immigrants who participated in the focus groups cited indicated a variety of reasons that exacerbated their access to health care and insurance. They included language barriers, legal residency, and/or citizenship status. A number of immigrants in the focus groups reported that they had not received medical attention from two to four years, and some had not visited a medical doctor since arriving in the United States.
• People used a variety of strategies for dealing with the lack of health
care coverage or under-insurance. A number of focus group participants indicated that they limited their use of health care services. Some mentioned prayer as a means of managing their health care needs. Inadequate insurance also prompted people to attempt a self-diagnosis of their ailments For those adults without access to health coverage, the emergency room constituted the primary site of care.
Child Health Issues According to a survey by the Urban Institute, 7 in 1999 approximately 24% of all children living in New York had public health insurance coverage through Medicaid, Child Health Plus, or State plans. Overall, 91.3% of children in New 6 Child Health Plus is elaborated on in Section 7. 7 The Urban Institute (2001, December). Health Insurance, Access, and Use: New York. Tabulations from the 1999 National Survey of America’s Families. State Profiles. Washington, D.C.: Urban Institute. Table 11: Characteristics of the Uninsured in New York, 1999.
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York had some form of insurance coverage, leaving, however, 8.7% without any insurance at all. For many parents caring for children, the lack of employment or employment with limited or no health benefits is a major problem. This is especially the case in low-income families whose economic vulnerability is compounded by the prevalence of chronic diseases among their children. Key Findings: • The majority of children had health care coverage. Among survey
respondents and focus group participants with children, 84% and 88% respectively had health care coverage for their children.
• Children were vulnerable to the loss of coverage. Among survey
respondents with health care coverage for their children, 20% had lost that coverage in the previous two years. The principal reasons were changes in employment status and eligibility for public benefits and sanctions or administrative errors. In addition, immigrants in the focus groups were frequently unaware that their children were eligible for Child Health Plus.
• People often felt that coverage was inadequate. Parents in the focus
groups raised concerns about the adequacy of coverage. These concerns centered on the re-certification process for Child Health Plus, the opportunity to have a health care provider of one’s choosing, and the limits to service within managed health plans. Their concerns were often the result of a lack of information concerning their options and overall procedures.
• Child health issues were a major concern for parents and guardians.
Children had a number of health problems; the most prevalent were bronchitis, pneumonia, and asthma. The majority of survey respondents had taken their child(ren) to a doctor between 1-3 times in the previous year. Eighty-two percent used an emergency room or hospital-based clinic. Parents expressed concerns about the continuity of care, the cost of care, not being informed of changes or loss of health coverage for their children, and the lack of information about health plans.
• The cost of health care could be prohibitive. While most children had
some form of health insurance, some did not. For those who had insurance, parents often had to pay out-of-pocket expenses for services not covered. Among survey respondents, 25% reported being billed for services and 6% paid on the spot. Focus group participants reported health care costs such as $1200 for x-rays, $500 for a tooth extraction, and $150 to fill a cavity.
• Parents used a variety of strategies for dealing with the lack of health
care coverage or under-insurance. With limited access to health care, parents often used the emergency room. Parents also reported using alternative, extra-biomedical approaches as well as limiting children’s social activities as a way of preventing illness. Parents also reported advocating for
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their children and using system procedures such as the fair hearing process to reinstate coverage that had been lost.
• People lacked information about Child Health Plus. Half of the focus
group participants had not heard about the program. Among those who knew of the program, many did not understand how the plan worked. Some thought their children’s health care needs would not be covered or that they could not select a doctor of their choice and many lacked appropriate information about the re-certification process.
General Perceptions of and Experiences with the Welfare Reform System
Time limits (up to five years) for the receipt of aid and work requirements are two of the most significant changes in the reformed welfare system. Recipients are supposed to be engaged in work or work related activities, such as educational and training programs. If there is non-compliance with these mandates then a person runs the risk of being sanctioned or having their case closed. These requirements, as well as interactions with the caseworkers responsible for enforcing the requirements, are what structure people’s perceptions and experiences of life under welfare reform.
Key Findings: • People felt that the new welfare requirements made life harder. Focus
group participants and survey respondents had considerable knowledge about welfare reform and the policies that comprise the new system. Their perceptions were typically negative, and several felt that the system was oppressive, racist and designed to make them give up trying.
• One of the most salient complaints about the system concerned
caseworkers’ treatment of welfare recipients. Recipients’ primary complaint was that caseworkers lacked respect. Focus group participants and survey respondents gave as evidence caseworkers’ inattentiveness especially by phone, the difficulty in getting in touch with caseworkers, and the lack of continuity in case management. Sixty-six percent of Blacks and 72% of Latino respondents found it difficult to contact their caseworker as compared to 50% of Whites and “other” respondents. Fifty–eight percent of Harlem survey respondents mentioned that it was difficult to contact their caseworker.
• Clients frequently reported that their cases were managed inefficiently.
Focus group participants’ most salient complaints were the time spent waiting to see their caseworker and the inadequacies in monitoring their progress, to the extent that some reported that they “managed” their own cases. For survey respondents, the principal problem concerned the lack of continuity in case management. An analysis of the eight job centers indicates that clients
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reported a mean number of three different caseworkers seen during the previous year.
Quality of Life under Welfare Reform While examining the impact of welfare reform in relation to health care and childcare in particular, other issues emerged in relation to the conditions in which people were forced to live. Overall the focus group and survey findings revealed that life under welfare reform is difficult. Key findings: • Food insecurity was a major concern. Thirty percent of survey
respondents had skipped meals due to lack of resources to buy sufficient food.
• There were racial differences in reports of food insecurity. While all
respondents suffered food insecurity, Blacks’ rate of food insecurity was nearly twice that of Whites and nearly 60% higher than that of Latinos.
• Paying bills had become increasingly more difficult. Overall, 69% of the
survey respondents reported that they found paying bills harder. Fifty-eight percent of the total sample indicated that they had been unable to pay their bills in the last year.
• Housing insecurity was a major problem. Eighteen percent of survey
respondents had been evicted in the last year, while 21% had moved because they could not afford to pay their rent. In addition, 34% of the sample had become homeless. Men were two times as likely to have become homeless in the previous year than women were.
• Housing insecurity varied by racial categories. In all indicators related to
housing, Blacks and those identified as “other” were more likely to experience housing vulnerability than any other racial/ethnic group. Nineteen percent of Blacks and 22% of those identified as other had been evicted in the previous year, compared to 18% of Latinos and 7% of Whites. Blacks and others were more likely to take in boarders to help them pay the rent, 7% and 11%, respectively. These two groups also moved in with others at the same rate, with 22% of each having done so. Finally, more Blacks and others became homeless, 42% and 44%, respectively, when compared to 20% of Latinos and 39% of Whites.
While a number of issues surfaced from the research, this report includes only policy recommendations for New York’s public health insurance programs and for childcare (see Appendix A).
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PART I
OVERVIEW
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1. INTRODUCTION Welfare Reform
In 1996, President Clinton signed the Personal Responsibility and Work Opportunity Reconciliation Act (hereinafter PRWORA). 8 This legislation consists of nine titles addressing Aid to Families with Dependent Children (AFDC) including; benefits for legal immigrants; the Food Stamp Program; SSI for children; Childcare; the Child Support Enforcement Program; modifications to the child nutrition program and the Social Services Block Grant. The 1996 reform eliminated welfare assistance as a federal entitlement for all eligible families. Under PRWORA, welfare assistance is now a block grant program where states receive a fixed-amount of federal monies independent of the number of people in need. This report focuses on the titles of the Act that address AFDC and legal immigrants (Titles I and IV).
Title I of the PRWORA, known as Temporary Assistance for Needy Families (TANF), replaced the AFDC program for women and children that had existed since the 1930s. The Act also replaced Home Relief for Single Adults, Jobs Opportunities and Basic Skill Training Program (JOBS), and emergency assistance with the Safety Net Program, a state funded program for childless adults. Title IV of the PRWORA restricts access to Federal public benefits to qualified aliens including aliens with permanent residence, and aliens who has been battered or subjected to extreme cruelty in the United States.
TANF is a block grant from the federal government, which provides states
with an annual Family Assistance grant. There is a five-year lifetime limit on the receipt of federal funds for all individuals, although states may legislate a limit of less than five years, or continue benefits after five years using state funds. The best-known component of the new program is the requirement that recipients meet increasing work participation rates and that all able-bodied welfare recipients must work full time after two years of receiving aid.
Conservative and neo-liberal politicians have lauded the success of welfare reform for decreasing the welfare rolls in the media. However, recent scholarship has pointed to the disproportionate impact of welfare reform policy on communities of color.9 Economic vulnerabilities due to race and ethnicity have
8 P.L. 104-193, 104th Congress, H.R. 3734, August 22, 1996. 110 STAT. 2105 9 See for example, Ana Aparicio, Dana Davis, Audrey Jacobs, and Leith Mullings (2000). Racial and Ethnic Disparities and Welfare Reform in New York State. New York: City University of New York. Also see Dana M. Davis (2001). Surviving Welfare Reform: Battered Black Women’s Strategies for Survival in Poughkeepsie, New York. Ann Arbor, MI: UMI Dissertation Services and, Linda Burnham (2001, September). Welfare Reform, Family Hardship and Women of Color. The Annals. American Academy of Political and Social Sciences. 577:38-48.
13
long been one aspect of poverty. The racial imbalance among those who constitute the poor has been accentuated by welfare reform policy, as immigrants, Latinas, African American and Asian women disproportionately absorb the punitive aspects of welfare reform. The W.K Kellogg Foundation Devolution Initiative10
In 1996, the W.K. Kellogg Foundation began the Devolution Initiative. It
was designed to build on the Foundation’s historical and ongoing interest in developing the capacity of people to shape and improve the quality of life in their neighborhoods and communities. The Devolution Initiative has provided support to researchers, policy analysts, state, and national organizations to build the capacity of community leaders to work together to accomplish three primary goals:
• Create an objective information base about the impact of devolution that is
useful and useable to a broad group of stakeholders, including community members;
• Share the findings with policymakers and the public; and • Use the information and other community resources to promote public
participation in informing policy agendas and decisions.
“Devolution” refers to the complex, shifting of responsibility and accountability from the federal government to state governments. Such changes demand an informed citizenry for accountability and they have the potential to provide significant opportunity for those at the local level to inform and implement policy. As the manifestations of devolution continue to unfold, the findings by the Kellogg grantees offer interesting insight into the effects of devolution in general and specific issues concerning healthcare and welfare reform. The Community Outreach and Research Project
In May of 2001, after one-and-a half years of providing technical assistance and engaging in preliminary research projects, the New York State Scholar Practitioner Team (see Appendix B) of the Kellogg Foundation Devolution Initiative developed the Community Outreach and Research Project. This initiative was organized in consultation with the three Devolution Initiative grantees from New York State (known as the New York State Partners): The Children's Defense Fund-NY, Inc.; Citizen Action of New York; Citizens’
10 The description of the Kellogg Devolution Initiative is adapted from the W. K. Kellogg Foundation website: http://www.wkkf.org/Programming/Overview.asp?CID=162
14
Committee for Children; as well as input from the New York Immigration Coalition.
Recognizing the disparate impact of welfare reform on communities of color,11 the goals of the project were two-fold: (1) to better understand the effects of reforms in health care and welfare in Harlem and the Lower East Side (for community descriptions, see Appendix C); and (2) to help build the capacity of disproportionately affected populations in New York City, particularly in Harlem and the Lower East Side to mobilize around issues related to welfare reform, particularly issues of affordable, quality and accessible health care and childcare. Objectives included: ! Building partnerships through community participation; ! Identifying community-based leadership; ! Developing locally based data useful for advocacy and grassroots
organizations.
In consultation with the New York State Partners, the members of the New York Team of the Scholar Practitioner Program developed a multi-faceted research initiative. The research team conducted focus groups and individual interviews in Harlem and the Lower East Side. The team also administered surveys to 200 people as they exited Manhattan Job Centers, the one-stop welfare centers and developed materials for distribution to community residents. Finally, a participatory research technique, Photo Voice, was undertaken. This involved providing welfare participants and the employees of community-based organizations with cameras to visually capture the impact of poverty and welfare reform in their communities. 11 Ana Aparicio, Dana Davis, Audrey Jacobs, and Leith Mullings. Op.Cit.
15
2. DATA COLLECTION This project relied on qualitative research strategies, primarily focus groups, to explore welfare reform in Harlem and the Lower East Side. The research team also administered a survey to collect quantitative data to supplement the qualitative information. The two methods are described below. Focus Group Methodology
The focus groups were organized in collaboration with four community-based organizations. Members of the New York State Team of the Scholar Practitioner Program conducted six focus groups between June and November 2001, 12 with a total of 33 participants. The process of identifying focus group participants involved contacting organizations located in Harlem and on the Lower East Side Team members recruited focus group participants by drawing on established relationships they had developed through their own community activism. In the case of the Lower East Side, the Citizen Action of New York provided additional support through their own contacts and relations with community-based organizations. The following organizations collaborated in recruiting focus group participants: ! The Maternal Infant and Reproductive Health Program. The Maternal
Infant and Reproductive Health Program offers people without Medicaid a range of services including pregnancy testing, HIV counseling, nursing, public health advisor home visits, and referrals for prenatal care at low or no cost. All consumers are screened for Child Health Plus (CHPlus) and Family Health Plus, two programs that provide health insurance coverage. 13
! Union Settlement Association. Since 1895, Union Settlement Association
has been dedicated to solving urban problems in East Harlem. Through education programs and human services, the agency promotes leadership development and fosters economic self-sufficiency to help individuals and families build a stronger community. It operates out of sixteen locations and annually serves more than 12,000 people of all ages with effective programs in education, childcare, counseling, nutrition, job training, and economic
12 Two focus groups were held in June, one in July, one in August, and two in November. 13 New York has provided health insurance coverage to children since 1991 through the state-sponsored Child Health Plus program. In 1999 under the State Child Health Insurance Plus (SCHIP), New York expanded Medicaid to cover children age 15 to 18 with family incomes up to 100 percent of the Federal Poverty Level. At that time, New York also expanded Child Health Plus to cover children up to age 19 living in households with family incomes up to 250 percent of the Federal Poverty Level. To address the insurance needs of uninsured adults, New York has expanded coverage through the Health Care Reform Act of 2000. One of the programs, Family Health Plus, expands coverage through Medicaid to parents with incomes up to 150 percent of the Federal Poverty Level and single adults and childless couples with incomes up to 100 percent of the Federal Poverty Level.
16
development. Union Settlement is a large local employer with a staff of 800 people.
! Harlem Congregations for Community Improvement. HCCI is an
interdenominational consortium of city congregations in the Harlem community. The denominations include Protestant, (Methodist, Episcopal, Episcopalian, Baptist, Church of God in Christ, Deliverance, Tabernacle), Muslim, and Roman Catholic. A nonprofit, multi-service organization that includes more than 1600 units of housing, a career center and a Family Life Center, HCCI is viewed as one of the model organizations in Central Harlem.
! Lower East Side Family Union. The Lower East Side Family Union
(LESFU) was founded in 1974 as a non-profit neighborhood organization with the goal of preventing the dissolution of families. LESFU’s mission is “to strengthen and preserve families. Their goal is to empower families, and to enhance the quality of family life through the delivery of culturally sensitive services.”
Recruitment Strategies
The Scholar Practitioner Team recruited focus group participants by contacting the Program Director or Executive Director of the above listed agencies. Team members worked with an agency representative to recruit focus group participants. The team distributed flyers two to three weeks prior to the scheduled time of the focus group and asked potential participants to call the Scholar Practitioner office to confirm their attendance.
The participants in the focus groups were all individuals who utilize
community-based organizations in Manhattan. Individuals attended the focus group sessions voluntarily (see Appendix D for focus group questions) and in return they received $20 for their participation. All focus group participants signed an informed consent form that was available in both English and Spanish (see Appendix E).
The focus groups were designed to capture a range of experiences that residents had in relation to welfare reform, including health benefits, work experience programs, sanctions and childcare. Of the 33 participants, 28 were women and 5 were men.
Two facilitators led the focus group sessions. One focus group was entirely in Spanish. The discussions lasted approximately 1-1/2 hours. The chart below details the focus group locations and the number and gender of the participants in each(See Appendix F for the focus group participant summary).
17
Table 1. Focus Group Location Chart
Location Program Total in Focus Groups Total Women Total Men
Harlem Maternal Infant and Reproductive Health Program
5
5
-
Harlem Maternal Infant and Reproductive Health Program
3
2
1
East Harlem Union Settlement (ESL Class)
6 2 4
East Harlem Union Settlement (Childcare Participant Program)
2 2 -
Harlem Harlem Congregations for Community Improvement
10 10 -
Lower East Side
Lower East Side Family Union
7 7 -
Totals
33
28
5
Data Analysis of Focus Groups
All focus group sessions were taped, transcribed and, where necessary, translated from Spanish into English. One of the team members developed an initial codebook for coding the data. Then the team worked together to refine the codebook using a strategy for maximizing validity known as the interpretive community. By creating an interpretive community based on collective discussions, the team strengthened its ability to analyze the data. A final version of the codebook was used to code all six focus groups. In analyzing the data, the paragraph was the unit of analysis.
To ensure the consistency of the data analysis, pairs of team members coded the data from each focus group. The percentage of similar codes was calculated for each pair. A score of 85% or more was considered reliable by the group. The three pairs had congruency scores of 85%, 87%, and 87% respectively, indicating that the codebook and inter-rater reliability was fairly high.
Codes were analyzed manually to determine the frequency with which
each appeared. Initially teams used the frequencies to assess which concerns were most salient. However, careful reading of the material suggested that even
18
if, for example, an issue only had a frequency of two, the experience was considered to be highly salient. Recent research has shown that welfare reform policy has had a disparate impact on communities of color14 and that the shifts in welfare policy influenced a number of related issues, particularly in the areas of health, childcare, and general perceptions of welfare reform. Several studies, as well as litigation in New York, suggest an adverse effect of welfare reform on communities of color. Given this, the Scholar Practitioner Team sought to explore the effects of welfare reform on people of color. In order to explore general perceptions of welfare reform, the team interpreted data with reference to the following questions: ! How do consumers evaluate welfare reform? What kinds of interactions do
they have with caseworkers? Do consumers have interactions with caseworkers that help them achieve economic autonomy? What is the nature of those interactions?
To explore experiences with child and adult health care, the team interpreted data with reference to the following questions: ! What are the barriers to accessing health care? Do participants' self-reports
indicate negative, positive, or neutral perceptions of health care programs? How do they understand health care programs? If there is an absence of health coverage, what strategies do residents employ? Where does health care fit into their scheme of priorities? How do differences between adults’ access and children’s access to health care play out?
Childcare data was interpreted with reference to the following questions:
14 See for example Ronald Walters (2002, January). Racial and Ethnic Disparities in the Era of Devolution: A Persistent Challenge to Welfare Reform. JCPR Working Paper 276. Available: http://www.jcpr.org/wp/WPprofile.cfm?ID=314 . Also see Robert E. Beneckson, Marvin Dunn, Anjenys Gonzalez, and Clara Marichal (2000). Racial and Ethnic Disparities in Florida Welfare Reform: A Study of Income Levels for Black, Hispanic, and White Post-Welfare Recipients. Available: http://www.academy.umd.edu/scholarship/AALI/spp2000networking/florida2.htm.
19
! Are participants given information about childcare options and payment for childcare? How do participants feel about leaving their children with providers?
Demographic Summary of Focus Group Participants
At the beginning of each focus group session, participants were asked to
complete an anonymous demographic summary form (see Appendix G) which asked participants about their age, race/ethnicity, place of residence, income, educational attainment, employment, benefits, and health coverage. Thirty of the 33 completed the form, though not everyone answered all of the questions, resulting in different samples sizes for each variable.
This demographic summary of focus group participants is not a random
sample; it is a sample of people associated with the community-based organizations with which the New York State Scholar Practitioner Team worked. The participants were not representative of the general TANF population. The graphs below outline key demographic data and represent only those who returned the demographic form.
Race/Ethnicity. Of those who returned the demographic summary form,
fourteen of the participants were African-American, 11 were Latino, 1 person was of Caribbean descent, 1 participant was African and 2 people did not indicate their race/ethnicity.
Race/Ethnicity of Focus Group Participants N=29
A-ALa tinoAfrica nC a ribbea nU nknow n
20
The Latino population was comprised of Puerto Ricans, Dominicans and Mexicans.
Latino Population of Focus Group Participants By Nationality
N=11
0
1
2
3
4
5
6
PuertoRican
Dominican Mexican
Number
Age. The respondents ranged in age from 20 - 75, with 22 (76%) of the
participants under the age of 41.
Age of Focus Group Participants
N=30
0
2
4
6
8
10
12
14
Number
20-2930-4142-5354-6566-75
Education. Of the reporting sample (n=26), 13 had completed 12 years
of education, and two participants had some post-secondary educational experience. The remaining 11 participants had less than a 12th grade education.
21
Educational level of Focus Group Participants N=26
0
2
4
6
8
10
12
14
< 12 grade GED/DIPLOMA College
Number
Household Income. Of the total sample that responded to questions
regarding household income (n=23), 14 reported incomes less than $5,000. An additional five households reported incomes between $5,001 and $9,999. As such 19 of the 23 households had incomes below 150% the federal poverty level for a family of two. No participants reported incomes between $10,000 and $15,000. Only 4 households reported incomes above $15,000.
Household Income of Focus Group Participants N=23
02468
10121416
< $5000 $5001-9999 $15-19999 >$20000
Number
Living Situation. Focus group participants made up 26 households. Two
households lived in a homeless shelter and 24 households lived in apartments. The average household size among apartment dwellers was 4.7 individuals which included adults, their children and other children, not their own. Households averaged 2.1 adults; the surveys distributed prior to the focus group, did not provide sufficient information to determine whether or not all the adults living in the same household were related. There was an average of 2.3 children in each household related to the responding adults.
22
Health Coverage. Twenty-five adults with related children responded to questions regarding health coverage. Sixteen indicated that they had health coverage, typically Medicaid; nine people reported that either no one or only some household members had health coverage. In the situation where some members of the household had coverage and others did not, we call this discordant coverage. Six respondents had discordant coverage. Table 2. Health Coverage of Focus Group Participants
Type of coverage Number Percent Total 25 100 All covered 16 64 No-one covered 3 12 Discordant coverage 6 24 DISCORDANT COVERAGE 6 100 Adult no/child yes 3 50 Adult no/some Children 2 33.3 Adult yes/some Children 1 16.6
Survey Methodology
This research was a study of specific communities in New York City, examining particular issues in relation to welfare reform. The Scholar Practitioner Team developed, pre-tested, and implemented a survey to provide a statistical picture of how community residents experienced welfare reform. The survey contained 62 items that also included one open-ended question (see Appendix H). The Human Rights Project of the Urban Justice Center provided technical assistance with the survey construction and analyzed the data. It is important to note that the individuals responding to the survey were not a random sample; consequently data from the survey are not statistically significant. However, the survey data resemble data from other studies exploring similar issues.15 The team analyzed the data using an SPSS database.
During October and November of 2001, the team administered a uniform survey to a set of individuals exiting Manhattan Job Centers in Manhattan. While the team was unable to visit Job Centers in the other four boroughs in the city, they covered all 8 job centers in Manhattan. As such, this represents a non-random sample of individuals applying for or receiving public assistance in New York. Interviewers visited each site three times and surveys were conducted outside each center. The interviewers informed respondents that they could refuse to answer any questions at any time or interrupt the interview. At two of
15 See for example Susan T. Gooden (1998). All things not being equal: Differences in caseworker support toward Black and White welfare clients. Harvard Journal of African-American Public Policy, 4:23-33. Also see Rebecca Gordon (2001). Cruel and Usual: How welfare “reform” punishes poor people. Oakland, CA: Applied Research Center.
23
the sites, the team administered the surveys in both English and Spanish. Response rates were not collected.
The eight job centers in Manhattan were Dyckman, East End, East Harlem, Hamilton, Riverview, St. Nicholas, Waverly and Yorkville. Two hundred surveys were collected, of which 196 were used for the analysis. The Harlem Job Centers were over-sampled because most Manhattan job centers are located in Harlem and this is where the majority of surveys were taken...The largest number of interviews was conducted at the East Harlem site with 42 (22% of total). The median number of surveys completed per site was 28. Ninety-five percent of the surveys were conducted in English, (5%) in Spanish, and 5 (2.5%) were missing information.
To prevent the study from being biased by applicants applying for benefits
due to 9/11, potential respondents were asked if they were at the Job Center because of 9/11. Only one respondent reported being there as a consequence of 9/11 and this person had a previous welfare case. Thirty-six (18%) of the respondents said they were applying for benefits for the first time, but many of these people reported having had prior contact with the welfare office.
The survey questions allowed the team to distinguish among respondents whose children lived with them from those whose children did not, with the goal of ensuring that data was collected on child specific issues such as childcare and children’s access to health coverage. Only those respondents whose children lived with them were considered for purposes of analysis. If a child was less than a year old, their age was entered into the database as 1 year old; therefore the mean for children's age is slightly skewed upward. Demographic Summary of Survey Respondents 16
The team targeted individuals receiving or applying for benefits through Job Centers in Manhattan. Although a few people lived in other boroughs, all interviews took place at job centers in Manhattan. The vast majority, 93%, lived
in Manhattan; 4% lived in Brooklyn; 3% lived in the Bronx and one respondent (less than 1%) lived in Queens. Twenty-nine percent of respondents lived in the zip codes 10035 and 10029. Fifty-eight percent were female and 42% were male. Eighty-eight percent were
16 All differences presented in the statistical data are actual differences. There were no statistical tests run to determine the significance or validi ty of the data.
B lack W o m en3 0 %
B lack M en2 6 %
La tin a2 3 %
La tin o9 %
W h ite W om en3 %
W h ite M en4 %
O th er W om en2 % O th er M en
3 %
24
U.S. citizens by birth, 6% were naturalized citizens and another 6% were permanent residents. Race. Fifty-six percent of respondents were African American or Black, 32% Latino,17 7% White, and 5% “other.”18 The ethnic groups (of all races) within the sample included Irish, Italian, Moorish, Pakistani, Salvadorean, and mixed-race. Puerto Ricans made up 60% of those categorized as Latinos. Black and Latina women made up slightly over 50% of the sample. Black men made up 26% of the sample compared with Latino men who made up 9% and White men who made up 4%. Below is a comparative chart of the racial/ethnic distribution of the New York State Scholar Practitioner Team’s sample in relation to the TANF population nationally and in New York City.
Table 3. Comparative Racial/Ethnic Percent Distribution of TANF Recipients
Race/Ethnicity National* New York City** NYS S/P Team Black 38.3% 33% 56% Hispanic 24.5% 59% 32% White 30.5% 5% 7% Other 0.6% N/R 5% Asian 3.6% N/R N/A Native American 1.5% N/R N/A Unknown 1.0% N/R N/A *Source: Public Agenda Online “Percent distribution of families receiving Temporary Assistance for Needy Families, 1999” www.publicagenda.org/issues/factfiles_detail.cfm?issue_type=welfare&list=11 **Source: National Center for Policy Analysis. “Hispanic Mothers Stay on Welfare in New York City.” Rachael L. Swarns, "Hispanic Mothers Lagging as Others Escape Welfare," New York Times, September 15, 1998. www.ncpa.org/pl/welfare/pdwel/pdwel175b.html. NR = Not Reported NA = Not Applicable
From Table 3, we can see that the survey sample had a reverse representation of Hispanic and Black recipients of TANF compared to New York City. This may be explained by two factors. First, most of the Job Centers in Manhattan are located in Harlem. Second, the Central Harlem Job Center is located in a neighborhood where over 90% of the population is African-American.
Marital Status. A majority (65%) of the 196 respondents identified themselves as single-never married. Twenty-three percent were separated, 17 Puerto Rican, Dominican, Mexican and self-identified “Latinos” have been collapsed for the purpose of the analysis. Numbers for each group can be found in tables in the appendices. 18 “Other” includes Asian, Pacific Islander, Caribbean and self-identified “others.”
25
Age Distribution of Sample
30-4143%
54-657%
66-771%
18-2925%42-53
24%
divorced or widowed and 12% were married. Of those legally married, roughly half were not living with their spouse, while 14% of those identified as single lived with a “partner other than a spouse.”19 Among the 65% who were single, 55% were women and 45% were men. When women and men were examined separately, the comparison presents a different picture. Men were slightly more likely (68%) to be single than women (63%) and less likely (7%) to be married than women (5%). There were also gender differences when analyzing the rate at which married couples lived together. Sixty-four percent of those single were Blacks, 26% were Latinos and 10% were Whites and “others.” When analyzing marital status within each racial/ethnic group, this gap decreases slightly with 73% of Blacks as single compared with 53% of Latinos and 46% of Whites. Whites were the most likely to be living together if they were married (15%) and Latinos were the most likely to be separated/divorced/ or widowed (see Table 4).
Table 4. Marital Status of Survey Participants, by Race.
African American
Latino White
Single-never married 73.4% 52.5% 46.2%
Separated/divorced/widowed 14.7% 36.1% 30.8%
Married living together 4.6% 6.6% 15.4%
Married not living together 7.3% 4.9% 7.7%
Total 100.0% 100.1% 100.1%
N= 109 61 13
Age. The respondents ranged in age from 18 to 75 with a mean and median age of 38. Forty-three percent were between 30-41 years old and 25% between 18-29. The mean age of women was 35 and the mean age of men was 41. Of the 25% that fell between 18-29 years of age, 19% of them were female and 6% were male. Of the 43% that were between 30-41, 25% were female and 18% are male. The 24% that fell between 42-53 were 14% male and 10% female. Given their overall numbers within the sample, African Americans and Latinos made up more than 19 This question had a non-response rate of 29%.
26
Gender breakout within race of those with less than a high school diploma
52.3
71.4
47.7
28.6
0 25 50 75 100
Black
Latino WomenMen
85% of those in the lowest age range. However, when racial groups were analyzed separately, Whites were more likely (39%) than any other racial group to be 18-29. African Americans were more likely (53%) to be 30-41 years old and Latinos where split (33%) between 18-29 and 30-41.
Education. Thirty-nine percent of the sample had less than a high school
diploma, 37% had a high school diploma or GED, and 24% had some form of higher education.20 Only 8 people indicated they were currently in school. Of those with the least educational experience (i.e. less than a high school diploma and no additional education), 58% were Black, 37% were Latino, 2.6% were White, and 2.6% were “other.” Across race, Latinos were more likely than any other group to have the least amount of educational experience. Table 5. Racial Distribution of those with less than A High School Diploma
Women made up the majority (60%) of those with less than a high school diploma, with Black women and Latinas making up 95% of this group. Among Latinos, women (71.4%) were much less likely
than men (38.6%) to have a high school diploma, while among Blacks the distribution along gender lines was more even (52.3 and 47.7 for men and women respectively). Black and Latino men were more likely than their female counterparts to have less than a high school diploma. This did not hold true for Whites. White men were more likely than White women to hold a high school diploma or higher.
Marital status seems to have some correlation with educational attainment. Sixty-three percent of single respondents (including those who were widowed /divorced/ separated) had a high school diploma or more compared to 48% of those who were married.
20 Those with less than an HS diploma did not participate in any other type of schooling after high school. Those that had a high school diploma or GED did not indicate having any additional education. The 24% that had some form of higher education could include people that do not have a high school diploma or GED, but it is highly unlikely.
Black Latino White Less than a high school diploma with no additional education
40% 46% 15%
N= 109 61 13
27
Living Situation and Children. Fifty-three percent of respondents lived in their own apartment or home, 14% were temporarily living with relatives or friends, and 5% were renting a room in an apartment or house. Another 18% were in a shelter and 7% were living on the streets or in a welfare motel. The average number of people living in an apartment or house was three, composed of one related adult and an average of two birth children. Forty-four percent of respondents were able to answer healthcare and/or childcare questions regarding children, usually their own children. Some respondents had children but they were not living with them and therefore were not considered part of the 44%. Limitations of Data There are a number of limitations of the focus group data. The first is that although we intended to focus primarily on childcare and health care issues, the shifts in welfare reform cut through participants’ feelings about those issues. Second, it had also been anticipated that comparisons of immigrant and native-born experiences with health and childcare would be made. However, access to immigrant community residents presented a challenge. There was only one focus group composed of immigrants, so direct comparisons were not possible, although their concerns are reflected in the overall findings of this report. In addition, it is important to note that all focus group participants were affiliated with community-based organizations. These participants were individuals with sources of support and some understanding of methods of accessing social services. Although we planned for each focus group to comprise between 5 and 7 participants, one focus group consisted of two participants. It should be noted that the same questions were asked of the focus group participants, regardless of the group’s size. With respect to the survey, some of the quantitative data is not contextualized by larger survey information. For example at the time this research was conducted, data on the racial distribution of the general Human Resources Administration TANF population was not available. Therefore we were unable to compare our sample with the HRA population at the time of our research. However, the main purpose of the survey material was to verify and substantiate information obtained from qualitative methods on the one hand, and to raise questions on the other. This report is organized in the following manner. Within each subject area, we first report the focus group findings. This is followed by survey findings, where applicable. In instances where either focus group and survey data are incongruent, we state such discrepancies.
28
PART II
FINDINGS
29
3. TRAINING and WORK EXPERIENCE PROGRAMS (WEP)
One of the main goals of PRWORA is to end the dependence of needy parents on government benefits by promoting job preparation and work. In New York State, the program is administered locally, and city governments have a great deal of leeway in designing their workfare program and assigning welfare recipients to work-related activities. The New York City workfare program, known as the Work Experience Program (WEP), is especially restrictive. Any individual receiving public assistance is expected to “work it off.” Single parents must work 20 hours a week or be engaged in work related activities and a two-parent family must work for 30 hours per week. If people receiving assistance refuse to work or are unable to do their assignment, they can be sanctioned or cut off from receiving benefits.21
Under the Giuliani administration, the overriding philosophy was “work
first.” The goal was to instill work skills to enable people to move from welfare to work, and as Jason Turner, the Human Resources Administration’s director under Giuliani put it, “The best preparation for work is working.”22 Beyond the mandated work hours, work related activities could be expanded to include job skills training related to employment, or education directly related to employment. However, the rubric of “job skills training” is highly inclusive, ranging from “hard skills” such as computer, clerical or other job-specific knowledge to “soft skills”, job readiness activities such as resume writing, interviewing techniques, job searching, and how to respond to your boss appropriately. Due to the structure of the WEP program, in practice most of the training that WEP workers have received has been in the area of “soft skills.” In a limited number of cases, focus group participants reported positive experiences with the training and WEP programs in which they participated. One Spanish-speaking participant in her 20s revealed that she had not had any problems at her training site. Based on her compliance, she was not monitored very closely by her caseworker. She completed a training program of which she was very proud.
Another focus group member, an African-American woman in her early 20s, was given a WEP assignment working as a receptionist at a New York City Health Department program. This young woman indicated she enjoyed her work and hoped she would ultimately be hired full time after completing six months of training, stating:
21 The issue of sanctions is discussed in more detail in section 5. 22 Jason DeParle (1998, December 20). What Welfare-to-Work Really Means. The New York Times Magazine, Vol. 148 Issue 51377.
30
I'm assigned there…but after a while, if they have a position open, then maybe I can get a permanent job there.
These two positive assessments of the training and employment programs associated with welfare reform were overshadowed by contrasting experiences and evaluations of other focus group participants. The Desire for Education
In 1988, the Family Support Act expanded educational options for welfare recipients. It allowed them to attend two or four years of college, depending on state provisions, and to count higher education as work. But the 1996 federal welfare law does not permit certain college programs to be counted as work. Yet, a study published by the Educational Testing Service, reported that the potential return on investment in education is great.23 A second study found that as little as one semester of full-time, post-secondary education can raise yearly earnings by as much as $10,000.24 This study noted that while one-third of welfare recipients did not have the preparation they needed to pursue advanced education, two-thirds of welfare recipients could benefit greatly from short-term education and training programs. However, the work first approach and work requirements often prevented women from obtaining the education that could lift them out of poverty.
Many of the focus group participants discussed their desire to obtain an education. Although most had completed their General Education Diploma (GED), several had not. Those who did not have GED diplomas recognized that education was one key to success. They indicated a strong commitment to participating in training and educational programs—if they could be certain that the goal of acquiring useful skills could be met. In some cases, obtaining a GED or high school diploma was not the goal, but rather post-secondary education was the objective. In the opinion of some focus group members, the desire to obtain an education was undermined by welfare policy. Some reported being forced to forego their self-initiated education programs. Thus one participant decried,
I had to leave CUNY [City University of New York] or else they were going to sanction me.
Another participant reported that she had to leave a vocational school she had chosen to attend in order to receive public assistance. In both cases, the women 23 Anthony P. Carnevale and Kathleen Reich, with Neal C. Johnson and Kathleen Sylvester (2000). A Piece of the Puzzle: How Education is making Welfare Reform Work in the States. Princeton, NJ: Educational Testing Service. Available: http://www.span-online.org/puzzle.pdf 24 Anthony P.Carnevale and Donna M. Desrochers Op. Cit.
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were required to attend government approved educational programs, not the programs they had initiated on their own accord.
Participants pointed out how frustrating it was not to be able to attend a
school of one's choice, but rather to have to go to a training program or a school approved by the Department of Social Services, which may not lead to job opportunities.
The educational levels of survey respondents were similar to that of focus group members. Nearly 40% of the respondents had less than a high school diploma, while 37% had a high school diploma or GED and 24% had some form of higher education. Only 8 people indicated that they were currently in school. For many of the survey respondents, going to school and securing higher education was an objective. They too reported that their self-initiated educational endeavors were challenged by caseworkers who wanted them to attend programs that were not congruent with the abilities participants felt they had. Restricted Opportunity
WEP assignments are not jobs and workers have neither benefits nor job protection. However, the City gains significantly from the labor of WEP workers at minimal cost (approximately $1.80 per hour which represents the city’s share of the welfare check). 25 One study has demonstrated that New York City's Work Experience Program uses welfare workers to do the same work as city workers, undermining the employability of unionized workers.26 An 18 year-old Latino male who was unemployed because of an injury commented that:
…They’re trying to put me in WEP. They’re only giving $168 every 2 weeks and only $25 in food stamps a month. I’m trying to have them help me go to college, get financial aid, and I need to get a job to maintain it. We need a job placement place for jobs that’s not WEP.
A mother of three felt that WEP and training programs were not going to
help her secure employment that would allow her to care adequately for her family. She noted that she needed “... something to back me up, so after you close my case I can keep moving” (#20).
In theory, the training programs are supposed to lead directly to
employment; at the end of seven months, participants are expected to be able to 25 The Committee on Social Welfare Law, Association of the Bar of New York City (2001, August). Welfare Reform in New York City: The Measure of Success. Available: http://www.abcny.org/currentarticle//welfare.html. 26 Andrew Stettmer (n.d.) Welfare to Work: Is it Working? The Failure to Move the Hardest to Employ into Jobs. New York: Community Voices Heard. Available: www.cvhaction.org.
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secure permanent employment. The City’s own figures speak otherwise. An HRA analysis of the first 5,300 individuals who had entered the job search program discovered a placement rate of only 5%.27 A recent study of individuals near or past their time limits found that for 91% of respondents, their WEP assignments had not resulted in a permanent job.28 Other reports have indicated that WEP has been more effective at reducing caseloads by cutting people off of welfare than helping them find jobs.29
For the most part, focus group members considered the training programs
available through social services and private agencies bereft of opportunity. Clients did not think that the training was worth much on the job market. The same mother of three cited above said:
I have not seen a computer room, not a training place… I haven't seen it. And I haven't seen them really teaching us anything to benefit us. People that have one or two kids in their household need a lot of training. I haven't worked in 10 years.
The training programs were not designed to equip recipients with skills to
compete in the market place. Participants typically reported having to gain work experience in the parks or in positions for which the "city has a hiring freeze."
Most focus group members noted that the work experience program took place in the park. The New York City Parks and Sanitation Departments have been the primary users of WEP workers. The Parks Department in New York City has aggressively utilized WEP labor. According to one report in early 1999 there were approximately 5,000 WEP workers assigned to the parks. 30 It has been found that WEP employees’ work has substantially improved the cleanliness of the parks during a time of stringent budgetary constraints. Their participation as a labor source neutralized the impact of cutbacks to the Parks Department between 1993 and 1998. Without WEP workers, New York City residents would have experienced a noticeable decline in the cleanliness of the parks during the 1990s.
27 Ibid. 28 Meredith Ballew, et al (Forthcoming). The Journey Toward Self-Sufficiency: Examining the Effects of Welfare Reform on New York City TANF Recipients Approaching Their Five-Year Time Limits. New York: New York University Robert F. Wagner Graduate School of Public Service/and Community Voices Heard. 29 Andrew Stettmer. Op. Cit. 30 Steven Cohen (1999, March). Managing Workfare: The Case of the Work Experience Program in The New York City Parks Department. Columbia University School of International and Public Affairs. Available: http://www.columbia.edu/~sc32/wep.html.
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Members from the focus groups indicated they welcomed the opportunity to work. However, they expressed concerns and reservations. First they noted that though the jobs to which caseworkers steered them often came with a promise of full-time employment, this rarely materialized. One young African-American mother of an infant said:
…Anytime they give you an assignment, you know, you would think that this assignment, if you'd been there for six months, at least you would get hired…I'm tired of getting into dead (end) situations. They know that these city jobs, they have a freeze on them. And everywhere they have a freeze. That's why they put me there. And I'm tired of that. That needs to be stopped. My resume is pretty good. I want to go somewhere. If you place me there for six months put me in a situation where I know that the people are at least hiring. Don't put me in where there is a freeze. That's what pissed me off the most.
Another participant stated,
How can you put a person out there to clean the street when some of them have education…they just put them in the street -- even with a diploma -- because that's all they have for now.
In addition to assignments not resulting in permanent employment, people
were concerned about the instability of any employment opportunities arising from the 6-month WEP assignment. One participant indicated that despite the fact that people may have performed well at their WEP sites for half a year, they were later laid off. A number of participants indicated that their benefits ended prior to the conclusion of the WEP assignment, but they had no guarantee of continued employment.
Subsequently, when they were terminated from their assignment they had
no other source of income. One focus group participant noted that despite the fact that welfare participants have complied with the regulations of welfare by working in WEP programs, they ended up in great difficulty because, at the conclusion of their work assignment, they needed assistance, but were denied it. While working at the WEP site, individuals have lost their benefits and then they have had to re-certify for benefits. It takes some time to be re-certified and in that time, according to focus group members, children and families found themselves in very precarious circumstances. The loss of income had pushed some toward homelessness.
Focus group participants expressed concern about the type of work that
people had to do -- such as park clean up and "digging in the dirt" that would neither lead to permanent employment nor improve life chances. Focus group participants were also concerned that working in a WEP program would not be
34
good role modeling for their children. They suggested that it was not simply working that influences a child’s future, but also the type of work one does is an important factor in how successful one’s children will be. Participants felt that WEP placements lacked dignity and would not motivate their children to do better.
They want you to do sanitation…go in the parks and pick up the trash. Sit in the street and walk around and pick up the trash. What do I look like to you? You think that's all I want to do for the rest of my life is pick up trash? I don't want to teach my kids that. And I don't want them to be in the rut that I'm in. I'm struggling for them so they can have a better life when they grow up.
Finally, for some women in the focus groups, their problem with WEP
programs was based on the fact that they wanted to be at home with their children. They described the problems of finding dependable childcare.
Survey respondents had very similar experiences with WEP and job
training programs. They too felt that WEP posed several challenges and barriers to achieving economic independence. One survey respondent articulated her feelings about the WEP program and how it has served as a barrier to employment:
I think the system is feudal. It defeats its own purpose. The city juxtaposes itself between you and your job. You gotta get an interview [with Social Services], to get an interview. (#117)
A second survey respondent, a 47-year old African-American male noted that he had:
…participated in a WEP program for a few months and was given an assignment in an office working for a Human Rights organization. He said that although he enjoyed this assignment and did learn new skills at the site, it did not lead to a permanent job (#79).
A single African-American woman in her late twenties with one child participated in WEP for 6 months. She said of her assignment: I picked up garbage in the street (#76).
Data from the surveys indicate that participation in the WEP and Job Search programs was racialized. More than 20% of Blacks and Latinos were in job search and the Work Experience Program compared with zero Whites (see Table 1 in Appendix I).31 Of those Blacks and Latinos who were in WEP, at least 31 The tables listed in this section begin with “1” and can be found in Appendix I.
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24% picked up garbage in streets and parks, 28% worked in an office and nearly a third of both groups did ‘other’ types of work or training programs. Although more than 30% learned new skills, only 7% of each group obtained a job as a result of their WEP assignment. Conflict with Non-WEP Workers At times there is an antagonistic relationship between WEP and non-WEP workers. Given that WEP workers are perceived to be replacing unionized labor, this is not surprising. This issue emerged in focus group discussions. Focus group participants complained that non-WEP employees were lax on the job. Some participants noted that as WEP workers, they felt they were doing work that non-WEP workers should be doing with them. WEP workers reported feeling that non-WEP workers took advantage of them and interfered with their ability to be self-sufficient by placing obstacles in their way. One woman reported that the non-WEP supervisor had not submitted her time sheets. As a result she was sanctioned for failure to go to work.
I was upset because I felt that that was very personal and I felt that …the person that actually worked there (the non-WEP worker), should be more consistent about putting my time sheet in…and that happened to me more than once…
Participants felt that as WEP workers they were in a very vulnerable
position because caseworkers had the power and authority to close their cases if they did not comply. The stigma associated with WEP assignments meant that WEP assignment supervisors devalued WEP workers efforts, exacerbating workers’ feelings of vulnerability.
Skills Mismatch Typically the term “skills mismatch” is used to describe an individual’s lack of skills which become a barrier to employment. In this case, we use the term to describe the skill capital that focus group participants indicated they actually possessed, but were unable to use in their work experience program.32
In several instances, focus group participants reported that their skill level was higher than that needed for their WEP placements. Many participants had long-term work experience and/or higher education. For example, one African-American woman in her 50s noted that she had years of administrative experience, but was told she had to work in the parks.
I worked for the attorney general, and now I work for the census off and on and Virginia Fields. And ok, I have a Bachelor's…[but]
32 The problem of skill mismatch emerged during the focus group discussions and was not contemplated in the survey design. As such, this issue was not captured in survey data.
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they're not getting you into the office. I have no problem about work, no problem about that. …So I made an appointment…I bring my resume and everything. He never did once look at my resume. He told me, ‘you’re going to the parks’. I said, ‘Excuse me, I'm standing up here in a dress suit, and you're telling me I'm going to the parks? This is dead in the wintertime’. He said 'You heard me, you're going to the parks.' I said, 'I don't think so. What do you mean, I can't be in the office or something?'. He said, 'No, you going to be out there with the rest of them.' He said, 'You need to take that'. I said, 'Oh no, no, no.' They promise you a job and everything and then they say, you have a job at a site for seven months with the City… But I mean… you could have your resume and what not, skills and things that you could use, [and] they tell you - it's dead in the wintertime – and then they go tell you, 'Work the parks' or else my benefits will be cut off.
Unemployment
The initial research did not focus on employment issues, therefore data
from the focus group demographic form did not capture the employment history of the participants. However, findings from the survey confirm a certain level of work experience among respondents. While less than 10% of respondents reported being employed, 60.3% of men and women had been employed in the last 5 years (see Table 2 in Appendix I). This suggests that recipients may have some skills that would allow them to be employed if jobs were available, challenging the belief that people on welfare do not want to work.
There were two principal barriers to employment for both men and women among survey respondents. The first concerned mental and physical health problems that prevented people from working and the second was the lack of available jobs. Health and health care was the issue that survey respondents raised most frequently about the barriers to work; of the total sample thirty-six percent stated that health problems prevented them from working. For example,
Survey respondent # 133 a 50 year-old African-American woman indicated that she had a chronic health problem that prevented her from working.
Survey respondent # 60, a 46 year-old Puerto Rican woman, said she was unemployed because of diabetes.
Seven percent of the sample said they were afraid of losing their Medicaid and two people said they did not have documents to work.
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Job availability was the second major problem. Thirty-nine percent of survey respondents indicated that lack of available jobs was the reason they were unemployed. An additional 20% of the sample referred to the difficulty in finding a job that paid a living wage as a barrier to employment. Several respondents commented on this issue:
I lost my job five months ago and haven’t been able to find one since (#114) – A mother of one. I was fired from my job in March 2000 and have not been able to find employment since (#111) – A male with 22 years work experience. “I can’t find a job, nor a job that pays enough money. All I need is a job –any job because I don’t want to live a life of boosting [stealing] (#21) – An African-American woman who is 21 years of age.
In contrast to the overwhelming number who emphasized the job market as the principle problem, only 14% of the sample cited the lack of job skills as a barrier.
Twenty-four percent of the total sample cited “other” issues that prevented them from working. These included recent release from prison and drug addiction.
While overall, men and women reported similar problems in finding a job,
there were also striking differences. Nine percent of women cited domestic violence, 8% were pregnant and 5% cited language barriers. Men did not cite any of these issues; rather, the inability to find a job was much more salient for them (see Table 2 in Appendix I). Women also mentioned the desire to stay at home. What they meant however, was not necessarily a lack of incentive to work, but rather very often a desire to take care of their children.
Interestingly while women mentioned insufficient job skills more often
than did men (17% compared to 10%), they were less likely to mention the absence of jobs overall than men (34% compared to 45%). Thirty percent of the men said they were unemployed because they had recently been released from jail and 10% of both men and women cited drug related problems. Twenty percent of the women cited a problem with their children, usually having to take care of a sick child, as a reason for their unemployment.
Roughly 30% of both men and women reported engaging in some other
kind of work to supplement their income. Fifty percent of the women provided some form of childcare or braided hair, while 30% of the men did “odd jobs.” There were also significant differences between racial categories with regard to employment and the reasons for unemployment. Whites were two
38
Work related barriers sited as reasons for unemployment
05
1015202530354045
Black Latino White Other
Not enough jobskills
Can’t find any job
Can’t find a job thpays enough
times more likely to be employed than Blacks (see Table 3 in Appendix I). Although Whites reported the least work-related barriers they cited domestic violence almost three times more often than Blacks and Latinos. The data also points to Whites
having more physical and mental health issues than any other group, although at least a third of all groups cited this as a work barrier. White respondents were the least likely to cite the lack of job skills or problems finding any jobs. Blacks and Latinos were more likely to cite inability to find a job that pays enough, 15% and 24%, respectively, as the reason for being unemployed, compared to 9% of Whites. This is not surprising given that seventy-six percent of Blacks and Latinos had personal incomes of less than $5,000 compared with 42% of Whites (see Table 3 in Appendix I). Further, twice as many Blacks and Latinos reported engaging in “other” types of work.
Finally, one other important barrier to employment was the lack of childcare, an issue discussed in the next section. Fifteen percent of the women cited the lack of childcare as an obstacle to employment. Of those unemployed, 18% of Whites cited no childcare as the reason for unemployment as compared with only 8.8% of Blacks and 11% of Latinos.
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4. CHILDCARE ISSUES
Since the enactment of the Personal Responsibility and Work Opportunity Reconciliation Act in 1996, the need for childcare has grown considerably, with more than one million single mothers entering the labor force since 1996. 33 As a result, changes in welfare included an allotment of funds to subsidize childcare costs, which are often beyond the means of low -income families.34 The funds available, however, come nowhere near to meeting the needs of New York working families. A recent study by the Citizens’ Committee for Children of New York estimates that 100,000 children between the ages of 0 and 5 are not receiving the subsidies for which they are eligible.35
Families have various options: they can use day care centers, family day
care providers or informal caregivers.36 Some parents, however, have not accepted mandated participation into the workforce. This has been the case in part because they have major concerns about who is caring for their children. In addition, New York State and New York City requirements that mothers work full-time or participate full-time in work activities once their children are three months old, is inconsistent with the reality that childcare slots for infants are few and far between.37 As one mother of three who was in the focus group noted,
… I felt like I was caught between a rock and a hard place because I wanted to work but having children at different ages and different grade levels…[it is hard finding a] reliable babysitter that you can trust.
Finding trustworthy childcare was of great importance to parents. Some
parents were concerned about the presence of drugs in informal childcare provider homes’. Others were hesitant to leave children with someone they did 33 U.S. Census Bureau (2000). Statistical Abstract of the United States: 2000, 120th edition. Washington, D.C.: U.S. Census Bureau. Table No 653. 34 See Linda Giannarelli and James Barsimantov (2000). Childcare Expenses of America’s Families. Washington D.C.: Urban Institute. They explain that lower income families do not pay out childcare costs as often as higher income families. However, when lower-income families do, their payout represents a higher share of the family income. 35 See Citizens’ Committee for Children (2000). Child Care: The Family Life Issue in New York City. New York: Citizens’ Committee for Children of New York. 36 Whereas the center-based and family day care businesses are registered by the state, informal providers are exempt. Usually relatives or a friend caring for only one or two children, unlike registered center-based and home-based providers, informal caregivers do not need to open their home to inspectors, nor are they required to participate in the training. 37 Hugh O’Neill, et al (2001). Policies Affecting New York City’s Low Income Families. New York: National Center for Children in Poverty, p. 8.
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not know, particularly if they had just moved to a new neighborhood. An African-American mother of two who was a resident in a homeless shelter articulated problems around accessing childcare that arose from being in a new neighborhood:
Well when I go [to work] I'm going to have somebody take care of them, but it has to be someone that I know, and that I'm cool with. I can't have them be with no stranger.
Distrust of strangers resulted in many parents reporting that they limited
their choice of childcare providers to relatives. However, focus group participants noted that even leaving children with relatives could be harmful. One focus group participant recalled coming home and finding her child burned. The child was in the care of the participant’s father. This suggests informal unregulated childcare arrangements even with relatives can be problematic. Although we do not have data about the particular childcare arrangements which focus group and survey participants were criticizing, it appears that their concerns centered on the quality of care within informal, unregulated childcare arrangements as compared to formal regulated center- or family-based childcare.
Childcare and Work
Some focus group participants did not want to participate in WEP programs because they wanted to stay home. For one participant it was not that childcare was inaccessible. Rather, she wanted to care for her children herself. She stated, "I had them, they're my kids." This same parent had previously used babysitters for her first two children. She went back to work when they were six months old. With her third child, she was clear that she wanted to stay home and care for the child herself. Taking care of her children herself, she implied, would ensure they would grow up to be healthy. She wanted to be prepared to re-enter the workforce and felt her readiness to work was directly related to her child’s development.
A second topic that was illuminated in the focus groups was the incompatibility of childcare with parental work schedules. Adults whose employment might involve working non-traditional hours were concerned about the availability and quality of childcare in the context of those circumstances. 38
Respondents to the survey raised similar issues and concerns about
childcare to those of focus group participants. The need for childcare was self-identified by those surveyed. Forty-nine of the respondents’ children were under the age of 6 and 47 children were between the ages of 6 and 10. While typically 38 Non-traditional work hours such as evening, nights, and weekends are often associated with certain types of low wage work such as home health aide.
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parents with children under age 6 need full-day childcare to be able to participate in WEP programs or job-related activities, parents with children 6 and over also reported needing childcare for after school hours.
Twenty-seven percent of the parents with children (n=169) reported that
they needed childcare in order to meet the work mandate. Of those who stated that they needed childcare, only 22% (n=10) had childcare. Of those who had childcare, 60% (n=6) sent their children to "friends," 20% (n=2) had ‘family members’ watch them, 10% (n=1) sent their children to private daycare and 10% (n=1) sent them to an agency. Four of these families paid out of pocket, four did not pay and only one used childcare vouchers. All of these people felt comfortable with their provider.
Of the respondents who reported not having childcare, 59% said it was
because they could not afford it. Nine percent said it was not safe, 9% said they had no information and another 9% had 'other' reasons.
Of those who answered questions about childcare needs and employment, 9% said that lack of childcare represented a barrier to working. This finding was not surprising and atypical given that in New York there is a disparity in the availability of childcare slots for children between the ages of 0 and 5 and the number of children in need of care.39
While 21% of the parents indicated that they knew how to apply for
childcare vouchers, only 13% had received childcare vouchers in the last year and 6% lost their childcare due to payment arrears to the childcare provider. Of the 10 people who applied for vouchers in the last year, only 4 of them received them.
Three mothers of young children (Survey respondents #195, #53 and #59), indicated they had never been informed of the availability of childcare assistance.
Childcare Vouchers/ Assistance Since 1990, New York City’s Administration for Children’s Services (ACS) have offered low-income parents childcare vouchers of up to $148 per week for whatever category of day care they chose.40
During the focus groups, it became clear that many people knew little to nothing about childcare vouchers or any childcare assistance. In some instances focus group participants knew about childcare assistance including vouchers, but had no idea how to access either. Among those who knew about childcare
39 See Citizens’ Committee for Children. Op. Cit. 40 Jerome Choo (2000, April 3). Childcare. Available: http://www.GothamGazette.com.
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vouchers, they uniformly felt the voucher system was not effective. Focus group members described situations in which childcare providers continuously filed paper work to ensure payment only to find that payments were rarely made in a timely fashion. Untimely payments meant the potential loss of a childcare provider:
"That's how you lose a babysitter. You can tell them [caseworkers], ‘my babysitter is getting mad and she's not receiving her money yet’… They're like, 'we're working on it, we're working on it.' "
According to results from the survey, only 8% of Blacks, 2% of Latinos,
and zero Whites had childcare vouchers/subsidies as part of their assistance package (see Table 4 in Appendix I). As might be expected, women were more likely to receive childcare vouchers/subsidies than men, 7% versus zero, respectively (see Table 5 in Appendix I).
Childcare—accessibility, affordability, and quality—remains a critical issue
for New York City, as is the case throughout the nation. The decision to create the Administration for Children’s Services (ACS), a freestanding agency, has resulted in more focused attention on the needs of children, parents and providers. A recent report issued in 2001 by ACS recommended ten goals for the agency. Two of the recommendations included increased access to childcare and expansion of the availability of care. To the extent that these recommendations are accepted and acted upon, parents will have an easier time moving from welfare to work.
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5. SANCTIONS and BENEFIT REDUCTIONS
Sanctions are one of several punitive measures for those who do not follow the work mandates or in some way fail to meet the conditions for the receipt of assistance. Usually it is due to non-compliance of a regulation. In some cases, non-compliance could mean simply missing an appointment or it could be due to circumstances beyond the control of the individual. Sometimes, however, welfare participants are sanctioned due to administrative error: Benefits are reduced or cases closed in relation to the increase in earned income. In either case, sanctions and benefit reductions often exacerbate economic fragility.
The swiftness with which cases are closed, benefits are reduced or
sanctions imposed, is very problematic. Members of the focus groups described how shortly after beginning a job, their benefits were cut or reduced. Most people thought a grace period would be useful: a timeframe during which benefits from their new job could kick in. Or, the benefits should be phased out more slowly, possibly using different guidelines. One African-American woman with two children suggested the following:
…They should have a way where they could have helped you, …where they don’t cut you off totally. Like until you get coverage…
Although the labor market was weak prior to September 11, it is important
to remember that in the aftermath, meeting the work-mandated requirements was compromised by factors beyond the control of individuals. With job loss and relocation initiatives, many were unable to secure employment. Sanctions
Sanctions, benefit reductions, and case closures are among the more punitive aspects of welfare reform. To be sanctioned is to have one’s benefits unavailable for a certain period of time, typically due to non-compliance of a regulation. Under these circumstances, people often face tremendous obstacles in trying to make ends meet. Several participants discussed the situation created by being sanctioned or having their benefits reduced. They argued that in order to sustain their families, they needed regular income support. For them, wages in the job market did not make up for the loss in benefits.
Of the 29 focus group participants who answered the question on the
demographic summary form regarding sanctions, 16 reported having been sanctioned within the last 12 months compared to 10 who had not been sanctioned. One focus group member said:
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In my case, I didn’t get money. They just gave me food stamps and then they reduced my food stamps because I was making a certain amount of money.
Focus Group Participants Sanction Status N=29
55%35%
10%
Sanctioned Not Sanctioned N/A
Another focus group participant reported:
I’m sanctioned right now. I’ve been sanctioned 3 times already…I missed a date [for the face-to-face interview]. I got the dates mixed up and I went down there the next day. They don’t tell you why you’re sanctioned, they just say you’re not complying.
One reason cases were closed was because recipients had found jobs.
Unfortunately the jobs were often only temporary, lasting only six months. During the time of their employment their cases were closed and benefits were lost. The new welfare policy, centered on attachment to work, did not predict the fragility of employment in various sectors of the labor market such as the service sector. The type of jobs TANF recipients were able to secure were not stable enough to warrant closing their cases or reducing their benefits. But case closures did happen, creating a great deal of economic hardship for the recipients. One might argue that cases should not be closed, but rather put on hold, since the reapplication process is time consuming and the waiting period often deepens economic fragility.
The perception of some focus group participants was that case closure
also occurred as a result of non-payment of medical bills to hospitals or health care providers. One focus group member claimed that instead of receiving a bill, a recipient is sent a closure notice for non-payment of a bill.
Yeah, instead of sending you a bill, saying you owe two months, they close it [your case] and then they’ll send you a letter saying it’s too late to re-open your case. That’s what they do.
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The issue of sanctioning, benefit reduction, and case closure was as
salient for survey respondents, as it was for focus group participants. Overall, 54% of the sample had had their benefits cut in the previous year and 35% had been sanctioned (see Table 5 in Appendix I). Having one's case closed most often occurred in relation to non-compliance with WEP.
I was sanctioned and I was cut off. And the time that they wanted me to go, [to the WEP site] I couldn’t because I have school-age children… the time that they wanted me to work was impossible. … When I reapplied three months ago, they denied me because I wasn’t in a WEP program.
One African-American survey respondent in her late 20s described her experience of being sanctioned for “failing to comply.” Unable to obtain a job in over four years, this single mother currently does not have health insurance for herself or for her 8 year-old child.
I was sanctioned in 1998 for ‘failing to comply’ because I missed my appointment. I missed my appointment because I didn’t have carfare that day.
Although she later received a fair hearing and managed to have some of
her benefits reinstated, she struggled through 4 years without benefits. There were racial differences in the rates of sanctioning and benefit reductions, among the survey respondents (see Table 4 in Appendix I). For example, Blacks, Latinos and those identified as other, were more likely to have had their benefits cut in the last year, than Whites. In fact, whereas 31% of Whites had their benefits cut, among all the other racial/ethnic groups, 56% had had theirs cut. Thirty-four percent of Blacks and 41% of Latinos had been sanctioned in the last year, compared to 31% of Whites.
There were also gender differences in reports of sanctioning. While 35% of the total sample of survey respondents had been sanctioned in the last two years, women were two times more likely than men to have been sanctioned and a higher percentage of women (60%) lost benefits than men (46%) (see Table 5 in Appendix I).
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Discovering the Loss of Benefits One measure of welfare reform’s success comes from the number of cases that have been closed. The methods of closing cases have been challenged and framed as "diversionary tactics."41
Focus group members reported that cases were closed (ostensibly due to some infraction) first and then they were informed. Some participants stated that they found out that their benefits were reduced or their cases closed when they attempted to access goods or services.
At least call me or send me a letter, okay. They just close it. And then you phone me.
Sometimes cases were closed in error and the diligence required to have
the case re-opened could be daunting. One young man in his 20s noted he had an exemption from work based on a letter from his physician stating he was not able to work. Yet he was identified as being non-compliant with the work mandate and his case was closed.
They have messed up my case, and they, see the people don’t do their jobs…I had to give them a letter to fix my case back up. Because they’ve messed it up. They’re the ones that messed it up.
Findings from the survey also revealed noteworthy racial disparities
concerning the ways in which welfare participants were informed of their sanctions. For example, 58% of Latinos and 53% of Blacks who were sanctioned received a letter informing them of their situation compared to 75% of Whites (see Table 4 in Appendix I).
One survey respondent in his mid-fifties talked about how he was
sanctioned for not responding in time to an appointment notice from HRA. He did not respond in time because, no longer able to pay his rent, he had to move and was not receiving his mail. Unemployed for over 5 years now, this respondent was staying with friends in an apartment and received no benefits at all. Although he had participated in various WEP programs, he had not learned any new skills and none of his job placements had led to permanent employment. He also suffered from painful chronic dental problems that he had been unable to address because of his lack of health care coverage.
The problems with health coverage reported by this respondent reflected a
significant pattern among survey respondents 42 years and older. Of those in
41 For a discussion of diversionary tactics see the Welfare Reform Network (1999, October). Applicant Diversion and Welfare Reform, Vol. 3, No. 7. Available: http://www.welfareinfo.org/pamresourceoct.htm.
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that age group, 40% had lost health care benefits in the last two years. This pattern was troubling given that 80% of this elder group also described chronic health problems and frequent visitations to the doctor or hospital.
A significant number of survey respondents reported that they did not know why their cases were closed. Orphaned at a young age, one 20-year-old respondent who is currently unemployed and renting a room for herself and her new-born in an apartment said that although she had had benefits in the past (before she became pregnant), she later lost them and did not know why. As a result she went through her entire pregnancy without health insurance and, consequently, without any prenatal care.
This is the third time this week I been to the office with the baby to apply. The last two times I came, they said I didn’t have the ‘proper’ documents. I applied for cash assistance before and they turned me down. Now I just want to get on Medicaid for me and the baby.
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6. “WITHOUT HEALTH THERE IS NO WORK:” ADULT HEALTH CARE ISSUES42
In 1999, 42.8% of New York's uninsured population was 18-34 years of
age. Thirty-four percent had an income of 100% to 200% of the poverty level. 43 One issue that may confound our survey findings with regard to Medicaid coverage was the impact of 9/11. We were not able to determine if people were suddenly enrolling in Medicaid, which was more accessible as a result of 9/11. 44
Participants in the focus groups were more concerned about the health and welfare of their children than their own. Lack of coverage for the adults meant they could not address their own health care needs. However, if adults do not take care of their own health, then their ability to take care of their families is undermined. As one participant noted, "Without health, there is no work." Access to Insurance and Health Care
Responses to the survey raised issues about adult access to health care and health insurance similar to those raised during the focus groups. Sixty-five percent of the survey respondents were covered by Medicaid or a private insurance plan at the time of the interview. However, access differed by race/ethnicity, gender, and location of residence (as this determined the Job Center one visited to obtain and maintain benefits and services).
Over 50% of all racial categories were insured, but Latinos were more likely to be insured than any other group (see Table 6 in Appendix I). Based on self-reports, Blacks and Latinos were twice as likely as Whites to have lost health benefits either due to job loss or sanctions. Of the Whites who had lost benefits, most indicated they had lost them due to administrative problems at the welfare office, such as a paperwork problem, as opposed to being sanctioned.
42 Policy Recommendations for New York’s Public Health Insurance Programs prepared by the Children’s Defense Fund – New York can be found in Appendix A. 43 The Urban Institute (2001, December). Health Insurance, Access and Use: New York. Tabulations from the 1999 National Survey of America’s Families. State Profiles. Washington, D.C.: Urban Institute. Table 1: Health Insurance Coverage of Non-elderly New York Population by Age, 1999. 44 As a result of September 11, New York established a Disaster Relief Medicaid Program, which enabled applicants to sign up for four months of “on the spot” Medicaid coverage”. The process involved the completion of a streamlined, single page application form. More than 75,000 New Yorkers enrolled in Medicaid in the first six weeks of the program.
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Generally, Blacks and Latinos are in poorer health than Whites. 45 However, in this survey, Whites reported more medical problems and had the highest rate of seeking medical treatment (eight or more times). All respondents had gone to the hospital or seen a doctor at least once in the previous year and approximately half of the sample had a chronic condition, with no difference by gender. Sixty-nine percent of Whites reported having a chronic condition compared to 51% of Latinos and 44% of Blacks. While 39% of Whites had sought medical treatment eight or more times in the previous year, 33% of Latinos and only 20% of Blacks sought medical treatment the same number of times. These findings contrast with studies that have examined racial differences in health outcomes. It may be the case that higher rates of Whites reporting a chronic condition on this survey could be explained by the possibility that 20% of Whites in the sample were on SSI, a higher rate than Blacks (5%) and Latinos (7%) (see Table 4 in Appendix I). Another possible explanation is that the Whites left on the rolls were the ones who were worse off than the general population.
Although we do not know whether the visits made to health care providers were the result of an acute condition, Whites went to the doctor more frequently than Blacks and Latinos. However, they did not report using emergency room care as often as Blacks and Latinos and in fact none had used the emergency room for their last doctor’s visit. This contrasted with 18% of Blacks and 15% of Latinos who used the emergency room for their last doctor visit (see Table 6 in Appendix I). While at least 50% of all racial groups paid for their last doctor visit with insurance, Latinos were more likely to do so than other racial/ethnic groups.
When insurance access is examined by gender, women were slightly
more likely to be insured than men. Nearly half of the sample had lost health benefits in the last year and within this group women had lost benefits at a higher rate that men, 49% as compared to 35% (see Table 7 in Appendix I).
While men had sought medical care one to three times in the previous
year at rates similar to women, women overall had gone to the hospital or to a community clinic more frequently than men. Across gender, more than half of the sample went to a hospital or hospital-based clinic the last time they went to a health care provider. Less than 17% went to the emergency room and less than 6% went to a private doctor.
Women were much more likely than men to use a community-based clinic.
Because women were more likely to be insured, they utilized insurance to cover the cost of medical visits more often than men did. However, among those without insurance, men and women did not pay their medical bills in the same
45 Sarah Stavetig and Alyssa Wigton (2000). Racial and Ethnic Disparities: Key Findings from the National Survey of America's Families. Washington, D.C.: Urban Institute, Series B, No. B-5. .
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way. Women were more likely to pay with cash, while men used a credit card or borrowed money to cover medical expenses.
Interestingly at different Job Centers, the rates of having health insurance varied. For example, those who were assigned to Job Centers below 34th Street had the highest proportion (43%) of people not insured. The Dyckman and East/West125th –126th Street job centers had the highest proportion of their population (75%) insured. Fifty-six percent of clients from the Hamilton Center had lost benefits in the last year compared with roughly 40% of those at all the other sites. The Dyckman Job Center had the highest proportion of its clients going to the doctor 8 or more times46 and East Harlem had the highest proportion of clients who went to the doctor 4-6 times (see Table 8 in Appendix I).
Discordant Health Coverage
One issue that emerged in the focus groups was that of discordant health coverage. This is defined as uneven coverage among family members whereby one or more people do not have health coverage while others in the family do. In comparison to children, adults in the focus groups were more likely to be without coverage – although they had health problems, most notably asthma and hypertension. Their lack of coverage was a barrier to addressing those health concerns.
Three types of circumstances gave rise to discordant health coverage. The first was when the parent was an immigrant and the child(ren) was born in the United States. The second circumstance was when the parent lost a job and his/her health coverage was discontinued, but he/she was able to secure Medicaid or Child Health Plus (CHPlus) for his/her child(ren).47 The third circumstance was when the parent was sanctioned and his/her coverage ended, but the child's coverage was continued.
Other reasons why adults lacked health coverage included:
! Non-re-certification: Many parents had their health benefits interrupted
because they had not completed the re-certification application. Often, however, parents stated they had not received applications or information for re-certification benefits.
! Complicated Paper Work: Respondents reported that the large amount of
paperwork required to apply for health coverage was more of an obstacle than lack of information regarding application procedures. The process of bringing in multiple documents on numerous occasions prevented people from even trying to secure health benefits, although it must be pointed out
46 This represents a high number of doctor visits and is an issue that needs further exploration. 47 Child Health Plus is elaborated on in Section 7.
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that adults reported more willingness to complete paper work for their children than for themselves. One mother said:
I shouldn't have to go through all of this that I got to go through just to get healthcare. I don't care if I don't have it, just for my children, it should be easier to get.
Immigrant Health Care Needs Immigrants who were able to access benefits and services faced concerns and institutional barriers similar to those of non-immigrants. However, immigrants’ problems were exacerbated for a variety of reasons, as they faced additional barriers such as language, legal residency, and/or citizenship status.
There were several immigrant participants in three of the six focus groups. They discussed the problems associated with being an immigrant and needing health care. In two cases in particular, participants described the difficulty of finding a translator who could facilitate discussions between the patient and medical personnel. Lack of interpreters meant that individuals were less able to advocate for themselves in order to obtain medical attention.
I went with my sister and her husband. She had high blood pressure and we went around midnight to Columbia Presbyterian. And I realized that, first of all Hispanics have problems. I had to create a commotion in there…they even called the police on me…my sister's condition was getting worse so I slammed a door and made a ruckus. I told her to look for an interpreter because my sister was dying…I couldn't permit that my sister died. And immediately I realized that if you're in one of those hospitals and you don't know English, you're in trouble…They can't have people that only speak English.
It is often assumed that only undocumented immigrants lack health coverage. However, those with papers and entitled to health benefits often forego interacting with health care providers because of the lack of interpreters. According to one participant, barriers to health care were sometimes a consequence of linguistic differences:
You don't have to be illegal to not receive medical insurance. I know a great number of people, Dominicans, Mexicans, Salvadorans, Indians, Africans, who have their papers but the language barrier...they don't get the orientation they really need…
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A number of immigrants in the focus group indicated that they had not received medical attention for two to four years. Some participants had not visited a medical doctor since arriving in the United States. For some, participants’ home remedies or “popular” methods were an alternative to using the biomedical system. Strategies for Dealing with Lack of Health Care Coverage or Under-insurance ! Limited use of health care services
A number of group participants indicated they did not go to the doctor or
limited their use of health care services, particularly if they had children. The possibility of being charged and not being able to pay was a factor in deciding whether or not to use emergency room care. One survey respondent described how she dealt with the lack of insurance:
I do not have health insurance, but I have trace tuberculosis. [When I’ve been sick within the last year] I use somebody's leftover medicine.
! Prayer
Some focus group participants used prayer to manage health care needs and
hoped they did not get sick. One immigrant male described how he prayed to God that he would never get sick. He noted how fortunate he was to have been in the United States for two years and thus far had no health problems.
! Self- diagnosis and assessing the gravity of health condition
Lack of insurance or under-insurance prompted some people to try to
determine what was wrong on their own. In deciding whether to seek medical care and whether to go to the emergency room or wait to see a doctor, they tried to assess the gravity of the situation. Though even those with coverage may undertake a similar process, for low or no-income people, the absence of access to specialists narrows their provider choices to either a general practitioner or emergency care. ! Emergency Room Utilization
As previously stated, for those adults without access to health coverage, the
emergency room constituted the primary site of care.
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7. CHILD HEALTH ISSUES48 According to a survey by the Urban Institute, 49 in 1999 approximately 24% of all children living in New York had public health insurance coverage through Medicaid, Child Health Plus or state plans. Overall, 91.3% of children in New York had some form of insurance coverage, leaving, however 8.7% without any type of insurance at all. For many parents caring for children, the lack of employment, or employment with limited or no health benefits is a major problem. This is especially the case in low-income families whose economic vulnerability is compounded by the prevalence of chronic diseases among their children.
Among focus group participants, child health issues were a major concern. Parents and guardians expressed a willingness to do anything to ensure that their children received appropriate and adequate medical care. They reported that their children had a number of health problems; the most prevalent were bronchitis, pneumonia, and asthma. During discussions, parents and guardians made clear the frequency with which their children required medical attention. Their ability to address those needs was encumbered both by the lack of health coverage and by a perceived lack of access to health coverage even when that coverage was available. Eighty-six survey respondents (or 44% of the sample) answered questions about children. The 86 respondents had 169 different children (49 under age six, 47 between the ages of six and ten, and 73 with children 11 or older). Eighty-eight percent of survey respondents with children were women, almost equally divided between Blacks (44%) and Latinos (48%) with the remaining 8% divided between Whites and others. In contrast, Latino men were three times more likely than Black men to have kids. The mean number of children per household was two.
Of the 169 children in the sample, 84% were insured. Sixty-eight percent required a hospital visit during the last year and 75% were insured in the last two years. Of those with insurance, 86% had Medicaid (although it could not be determined if it was managed care Medicaid or fee for service) or CHPlus, 6% had private insurance, and 8% had other types of coverage.
48 Policy Recommendations for New York’s Public Health Insurance Programs prepared by the Children’s Defense Fund – New York can be found in Appendix I. 49 The Urban Institute (2001, December). Health Insurance, Access, and Use: New York. Tabulations from the 1999 National Survey of America’s Families. State Profiles. Washington, D.C.: Urban Institute. Table 11: Characteristics of the Uninsured in New York, 1999.
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Adequacy of Health Coverage When asked if their children had health insurance (the terms health insurance and health coverage were used interchangeably) a number of focus group participants indicated that their children did not have insurance. But in fact over the course of the group discussions, it was revealed that children did in fact have coverage -- often Medicaid coverage, but that the parents did not consider this to be coverage.
“With her (the participants' daughter) we don't really have coverage…. I use her Medicaid card.”
Parents’ perception that coverage was inadequate was due in part to
issues concerning re-certification of Medicaid and Child Health Plus (CHPlus). Several respondents, for example, said they had taken their child to a clinic or hospital and found out during the visit that their child no longer had coverage. The reason that some people did not have coverage was because they had not re-certified.
Parents also perceived child health coverage as inadequate if they
thought that they could not choose their health care provider. In many instances, when people have managed care plans they have the option to choose a provider for their child(ren). If they do not choose a provider, they are automatically assigned to one. People are supposed to receive a letter informing them of their right to choose a doctor. In some cases it appears that people do not receive their mail and are auto-assigned a doctor. The auto-assignment process conflicts with the concept of choice.
In addition the limited number of visits in managed health plans
contributed to parents’ perception that their children did not have coverage. One parent had a Medicaid managed health care plan under which her daughter received coverage. The daughter's school had a dental program in which the mother agreed to allow the child to participate. At a later date, she took her daughter to another dentist and was informed that there was only one more permissible dental visit. "We only went to the dentist one time…I don't understand, what's the use of having Medicaid if they put a certain amount of visits on your card?" The mother did not believe that the school dental program should be able to access her Medicaid card and charge that care against her future option to choose a dentist for her daughter. Theoretically the cap on visits for children can be raised, but none of the respondents seemed to be aware that this was the case. Measures of Inadequacy
Twenty-five (20%) survey respondents whose children were insured in the last 2 years became uninsured. Fourteen children lost their insurance as a
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consequence of paperwork problems and ineligibility. Three parents were sanctioned, two said it was because they lost their job and five parents did not know why the children lost their insurance. In some instances when focus group members talked about lack of coverage, they were describing inadequate coverage.
Some focus group participants had children who did not have any health
coverage or insurance. There were three circumstances under which children might lack or lose coverage: employment status, immigrant status and sanctioning or paperwork problems. ! Employment Status
Among focus group participants, typically the loss of coverage occurred
when the parents’ employment status changed. Parents’ employment status had an immediate impact on the types of coverage that were available to their children.
For example one focus group participant noted that her child was enrolled
in Child Health Plus (CHPlus), 50 New York State’s health insurance plan for children. Since entry into CHPlus is connected to family income, when this mother lost her job, she was no longer able to pay the premium. She then applied for and received Medicaid. She later found employment that included health insurance coverage – HIP, but it did not begin immediately. The transitional Medicaid benefits were cut. This mother then relied upon the services of Metropolitan Hospital to meet her daughter's health care needs. This example illustrates how parents' employment status affects the continuity of health care for children.
50 To be eligible for either Child Health Plus A or B, children must be under the age of 19 and be residents of New York State. Gross family income determines whether a child qualifies for Child Health Plus A or Child Health Plus B. Children who are not eligible for Child Health Plus A can enroll in Child Health Plus B if they don’t already have health insurance and are not eligible for coverage under the public employees’ state health benefits plan. There is no monthly premium for families whose income is less than 1.6 times the poverty level. That's about $460 a week for a three-person family, about $560 a week for a family of four. Families with somewhat higher incomes pay a monthly premium of $9 or $15 a month per child, depending on their income and family size. For larger families, the monthly fee is capped at three children. If the family's income is more than 2.5 times the poverty level, they pay the full monthly premium charged by the health plan. There are no co-payments for services under Child Health Plus, so parents do not have to pay anything when their child receives care through these plans. If a child is enrolled in Child Health Plus A, they may be required to enroll in a managed care plan, or the child may be brought to any provider who accepts Child Health Plus A. If a child is enrolled in Child Health Plus B, a list of providers near ones home is provided. The provider may be a single doctor, group practice of several doctors, or community health center. If it is a group practice, the participant is asked to choose a doctor for their child.
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Number of times children went to the hospital last year
0.0 20.0 40.0 60.0
1-3
4-6
7-8
8 or more
! Immigrant Status
Although New York State made CHPlus available to undocumented children, focus group participants were unaware of this. The perception of limited accessibility to health care has had a negative effect on immigrants. The participants in one focus group in particular discussed the lack of health coverage for people without documents. Their perception was that the only alternative was to utilize the emergency room, although community health centers were also available.
! Sanctioning or Paper Work Problems
Children also lacked coverage because parents had been sanctioned.
Parents often did not find out that their children had no coverage until there was an emergency. Being billed for emergency services compounded the frustration of not having coverage when an emergency arose. It must be noted that although public hospitals have charity care, people were not aware that this option was available.
I went to take my son to the hospital and… they told me that he couldn't be seen…he had an asthma attack, and she put in the card and everything and she told me that she couldn't see him. So I took him to emergency.
A number of focus group participants discussed another health concern:
the cost of care associated with emergency room services. However, health costs that most concerned parents were those associated with prescription drugs. Parental Concerns about Children's Health Care Survey responses indicated that 61% of children who needed medical attention in the last year saw a doctor 1-3 times, 27% saw one 4-6 times and 11% saw a doctor more than 8 times. Eighty-two percent used an emergency room or hospital-based clinic. Only 17% used a community clinic and 11% used a private doctor.
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! Continuity of Care Most focus group participants expressed the desire for continuity in
providers, elaborating on the importance of their children growing up with one physician who cared about their child's well being.
And I need a doctor that cares about kids. And I wanted them to be with somebody who was with them more than two months or a year. So when they grow up, they can say, 'oh I've had Dr. Lamb since I was two months old'."
! Cost of Care
Parents in the focus groups reported being billed daunting amounts for their children's health care costs. They reported costs even when there was coverage: one parent reported being charged $1,200 for x-rays, another charged $500 to get her child’s tooth pulled, and another $150 to fill a cavity. Furthermore, child well care programs did not always meet children's health needs. One mother explained that she had a wellness plan for her child. When the child got sick and was taken to the doctor, none of the services she needed were covered. She was charged for services when her child was sick, but paid nothing for check ups. She said:
It's not fair to the parents that are not working, who have no income…now you've got to struggle to find somewhere to keep the child from getting sick, really sick.
Among survey respondents, the majority of their children were insured
and therefore 62% of parents had their medical visit covered by insurance the last time they went to the doctor. However, 25% of the respondents were billed for the services and 6% paid in cash or borrowed money, while 6% did not pay at all.
! Information about Health Coverage Status
Parents resented the lack of notification concerning changes in their child(ren)s’ coverage. They felt it was disrespectful and embarrassing to think they had coverage, only to find out they did not.
And they don't notify you or let you know. They don't tell you nothing until you take that child to the doctor and pull out that Medicaid card. And it comes up on the computer that you don't have health coverage. And then the lady's looking at you like 'Didn't they tell you?’
The respondents’ perception was that changes in coverage often occurred because they were unable to pay for uncovered services. They reported that
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they were billed for services, and when they could not pay, they then lost the basic coverage. With public benefits, however, people do not lose coverage due to payment arrears. Unaware of the need to re-certify each year, people probably lost their coverage because they had not submitted an application to be re-certified or had not received information about re-certification. ! Plans not accepted at preferred locations
Parents/guardians disclosed their frustration with the lack of information about health plans. Although with Medicaid people can choose a plan, participants sometimes were unaware that this was the case or did not complete the forms. As mentioned previously, in this case, clients would be automatically assigned to a provider. When respondents were unable to choose a provider, people still felt a loss of control.
If you got certain coverage and say down the street there's a clinic. Say I got Bronx Plus and they (the clinic down the street) doesn't deal with Bronx Plus and I need to get there, they’re gonna tell me to call the Bronx Plus and find out where I can go nearest to your zip code.
Strategies for Dealing with Lack of Health Care Coverage or Under-insurance Focus group participants reported employing the following strategies to deal with lack of or under-insurance. ! Emergency Room
People weighed the gravity of the illness in assessing whether or not they
would go to the doctor. One father reported that he always used the emergency room for his daughter's asthma problems. Another focus group participant, a male, stated:
I live right next to a hospital in the Bronx. The day that I get sick, may God never permit it… that’s where I’ll go.
! Alternatives /Popular Medicine/Extra-biomedical approach
Parents worked diligently to ensure that their children did not get sick, using alternative methods to achieve optimum health, such as feeding children fresh vegetables and, using tea tree oil to ward off illness. The extra-biomedical approach included making sure children were dressed appropriately for the weather to ensure that they “never got a cold.”
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! Limiting Children's Social Activities Without coverage parents were fearful of letting their children play freely.
One mother reported that since health care costs were prohibitive she was hesitant to let her daughter go to the park, lest she get hurt. ! Advocating for Their Child
In the event that parents were dissatisfied with the service provided by their health care provider, they made demands to have the health care needs of their children met. They asked for the supervisor or threatened to sue.
! Using System Procedures
Lack of coverage compelled a number of focus group participants to use the fair hearing process for reinstatement of Medicaid, a strategy that was successful for some, but not all. Child Health Plus
The research team asked all focus group participants if they had heard about Child Health Plus (CHPlus). There was an almost even distribution of people who had heard about CHPlus and those who had not.
While a number of people had heard of Child Health Plus, they did not
think all of their children’s health care needs would be covered under the plan. Some did not believe they would be able to go to a doctor of their choice if they moved.
In one case a parent reported that she had applied for Child Health Plus,
but had never received a response about her eligibility. Another participant indicated she was not able to receive CHPlus, because her income exceeded the eligible limit.
Generally there was inadequate knowledge about Child Health Plus. This
was particularly the case with regard to re-certification. A number of focus group participants did not know they had to re-certify for eligibility each year. As a result some had lost CHPlus coverage and therefore did not think it was a viable health insurance option. Others seemed to prefer the old Medicaid to CHPlus, as they felt they had more control over choosing specific health care providers.
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8. THE STRUGGLES OF WELFARE REFORM: PARTICIPANTS’ GENERAL PERCEPTIONS OF AND EXPERIENCES WITH THE WELFARE
REFORM SYSTEM
Since 1996 the welfare system has been overhauled—programs were eliminated and some new programs were initiated. In its earliest phases, as is the case now, Welfare Reform has been lauded as a more effective way to assist poor and working class people. Under the 1996 law, states operate programs and implement policies and procedures within certain parameters determined by the federal government.
Time limits (up to five years) for the receipt of aid and work requirements, as discussed earlier, are two of the most significant changes in the reformed welfare system. Recipients are supposed to be engaged in work or work related activities, such as educational and training programs. If there is non-compliance with these mandates then a person runs the risk of being sanctioned or having their case closed.
Focus group members had considerable knowledge about welfare reform
and the policies that comprise the new system. Participants were fairly clear about the issue of sanctions, time limits, and the focus on work.
I heard that Governor Pataki had introduced a new law stating that you have sixty months to be on public assistance. After sixty months, then they cut you off public assistance and they assign you to a job working in most likely the streets, cleaning the streets, working with the parks department.
Focus group members’ views of key policy elements such as measures taken for non-compliance such as sanctions and benefit reductions and their feelings about welfare reform were typically that welfare reform had made life harder.
…the thing that I don’t like about this is that the welfare reform is to keep us oppressed. It’s to keep us down. It’s not to elevate us.
Survey respondents’ comments about welfare reform and the system were
similar to those of focus group members. Many had negative perceptions of the welfare system and welfare reform. For example, one 40 year-old single African-American woman who had applied for assistance because she lost her job in June 2001, said:
They [the welfare system] take care of whom they want to take care. They discriminate against certain kinds of people…the system sucks…it’s a racist system. I can’t have the American dream. (#114)
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Another survey respondent said:
[I] do not think that the welfare system will ever change, and they’ll just keep making it so hard that you’ll have to give up. (#75)
Focus group members and survey respondents reported several ways in
which welfare reform was problematic. Two of the most significant issues were caseworker treatment and caseworker inefficiency. Caseworker Treatment
Many focus group participants considered welfare reform to be a “trap” and were especially vocal about negative interactions with caseworkers. Recipients’ primary complaint was that caseworkers lacked respect.
One woman described how her caseworkers did not provide her with the information that she needed:
I don’t like to deal with welfare…because it’s a mess. It’s a mess. Like, they just don’t do things. Why? And they don’t have the right information. And you’re lost. Right now I’m lost because nothing is working.
Focus group participants also cited caseworkers’ phone behavior as
evidence of their unwillingness to assist clients. One African-American woman noted "When you call them, they don’t pick up the phones. The phones be ringing off the hook—." A second participant, an African-American woman in her 20s, described her interaction with a caseworker who simply hung up on her: .
Well one time I called my worker…and he hung up the phone on me. I kept trying to call him back to ask ' why are you hanging up?' That’s very rude. You’re an adult, act like an adult.
Focus group participants suggested that the lack of caseworker
supervision in day-to-day interactions resulted in disrespectful treatment. Participants told us that without supervision, caseworkers were allowed to treat consumers in any way they wanted -- with an attitude.
Studies have demonstrated that caseworkers are overworked,51 which may be one reason that they are inattentive. The survey employed in this study did not explore that possibility, but used two other questions as indicators to understand caseworker treatment of clients. The first question asked how easy or difficult it was to get in touch with one's caseworker. The second asked whether there was continuity of case management. 51 Mimi Abramovitz, (2002). In Jeopardy: The Impact of Welfare Reform on Nonprofit Human Services Agencies in New York City. National Association of Social Workers, pp.31.
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Findings from the survey also suggest racial disparities in caseworker
treatment (see Table 9 in Appendix I). For example 66% of Blacks and 72% of Latino respondents found it difficult to contact their caseworker, while 50% of White and “other” respondents indicated it was difficult to contact their caseworker. Fifty-eight percent of Harlem respondents to the survey indicated that it was difficult to contact their caseworker. One survey respondent, a male, said:
They need more caseworkers that are properly trained to work with people. They just don’t care (# 111)
Another person who completed the survey noted that:
It’s very difficult to contact them [caseworkers] with problems, because they don’t answer the telephones and they do not keep accurate information in your case file or records (#195)
Caseworker Inefficiency
Both focus group participants and survey respondents expressed perceptions of caseworker and systemic inefficiencies. Focus group participants’ most salient issues referred to the time spent waiting to see their caseworker and the inadequacies in monitoring their progress. They noted that long waits at job centers were common. Many clients who brought their children with them to job centers expecting to get out quickly were often unprepared for these long visits.
I see kids crying, mothers ready to be interviewed [at the HRA offices], two hours three hours because they’re hungry, because they need a bottle of milk. I don’t think they should wait that long…
Inadequate monitoring of client progress was also seen as a result of
caseworker inefficiency. For example, focus group participants stated that they had to be persistent in ensuring their cases were being handled properly. This occurred particularly around increases in income. Participants were aware that when a person's income from employment reached a certain level, benefits were supposed to be reduced or cases closed. They knew that if appropriate measures were not taken, recipients ran the risk of owing "overpayments". Consequently some reported that they "managed" their own cases. They did so because caseworkers were not always diligent in monitoring client wages, even when the client told the caseworker of wage increases. One focus group member described how she was the one who reminded her caseworker to close her case because she was working. The participant noted that it took six months to get her case closed.
… I told them I was working, I told my caseworker. After three months I realized she didn’t cut it and I called her…because they
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penalize you when you're working and you’re on public assistance. 'I don’t want to be penalized because I told you I’m working right now.' I said to her, ‘Please close this case’.
What emerged most clearly from the surveys were the inefficiencies
surrounding the number of caseworkers that respondents had seen during the previous year. An analysis of the eight Manhattan job centers shows the mean number of caseworkers that clients across all of the sites reported having had during the previous year was three. The average number of caseworkers seen by a client was higher for Dyckman and East Harlem than at other sites. Based on survey responses, these two sites also had the highest rates of clients who said it was difficult to contact their caseworker.
Survey respondents described other problems as well. One individual
described how her caseworker was unable to “flag” her case file as exempt from working because of unusual childcare responsibilities. This woman was caring for her own three birth children and was the guardian for nine nieces and nephews who had been abused. The time she spent taking her nieces and nephews to various therapies resulting from abuse prevented her from participating in any work readiness programs. However, she continued to be called in for face-to-face interviews because her caseworker could not or would not enter the information in the system. Another survey respondent, a 20 year-old Puerto Rican woman with an 8-day old baby explained:
I’ve been here three times this week to apply for benefits. They’ve sent me home because I did not have proper documentation for Medicaid. (#78)
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9. QUALITY OF LIFE UNDER WELFARE REFORM Nationally, the welfare caseloads declined 59% from 5.1 million between
1994 and 2001. Thus, Democrats and Republicans alike continue to praise the success of welfare reform. But the self-congratulatory posture is marred by the fact that welfare caseloads are rising again, attributable to the weak economy. 52 Further, the quality of life for many has not improved.
This research sought to examine the impact of welfare reform in relation to
health care and childcare in particular. While exploring these issues, other issues in relation to welfare reform emerged. Overall the focus group and survey findings revealed that life under welfare reform is difficult for most. Three areas related to well-being were especially significant:
• Food Insecurity • Paying Bills • Housing
Food Insecurity A New York City report found that in 2001 more than1.5 million New Yorkers rely on free food from soup kitchens, food pantries and shelters to avoid going hungry. 53 Food insecurity describes a situation in which a person does not have assured access at all times to enough food to lead a healthy, active life. Access to food is one measure of hardship and nearly 23% of non-elderly families in the nation experienced food hardship in 1997.54
Food insecurity was a major concern of many focus group participants. Several group members had experienced the loss or reduction of food stamps. Their anxiety about food insecurity was often based on what participants felt were the arbitrary decisions made by caseworkers in relation to sanctions. Ultimately this meant they were unable to feed their families adequately. An African-American woman in her 30’s with three children had this to say about reductions in her monthly food stamp allocation:
If I'm used to going shopping for $300 worth of food, I look like a fool going into the supermarket with $70. What is $70 going to do with a household of four women (the woman and her three daughters)?
52 Douglas J. Besharov (2002, July 16). Welfare Rolls: On Rise Again. The Washington Post. 53 Food for Survival, Inc. (2001). Hunger in America 2001: The New York City Report. 54 Sarah Staveteig and Alyssa Wigton, Op. Cit.
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Another woman living in a homeless shelter complained that:
Now they only give me $118 in food stamps…what is that gonna do? My daughter is 15 years old, and [I have] a seven year old.
A young African-American father in his twenties with two children felt that reduction in the monthly food stamp allocation amounted to cheating recipients out of what they needed to survive.
Did I tell you how much food stamps you get? I think for three people you get like, $335 per month or something…they’ve cheated me.
In an attempt to have food stamp benefits reinstated, people used the fair
hearing process. However focus group members complained that the Government’s policy of 60 to 90 days as the waiting period before benefits kicked in, was problematic.
In some instances food stamp reductions occurred based on the adult budget, but did not affect the child’s food stamp allotment. However, as one African-American mother of three pointed out, if she experiences food insecurity, it impacts her whole family. As she stated: “…If you shortchange me, they lose out.”
Data collected from survey respondents indicated a racial
disparity with regard to food insecurity (see Table 10 in Appendix I). While all respondents suffered food insecurity, the rate of Blacks was nearly twice that of Whites and nearly 60% higher than Latinos in terms of not being able to buy food. Across all racial groups, meals were skipped, with 30% or more of each racial/ethnic group having done so. One survey respondent with two children who had recently lost her job said:
I cannot afford to buy food for myself or my two children. I rely on the Church’s food pantry to eat (# 116).
Nationally, research has found that differences in food hardship indicate racial disparities. Among the nonelderly, Hispanics, Blacks and Native Americans were twice as likely to have food problems as Whites or Asians. 55 When analyzed by gender (see Table 11 in Appendix I) the survey showed that men and women were almost equally unable to buy food, at 41% and 39%, respectively. However, women were more likely to have skipped meals than men, 41% and 34%, respectively. Men relied more on community services for food (38%) than women who did so at 34%. 55 Ibid, p. 3.
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Paying Bills The second aspect of hardship was reflected in daily economic activities. Survey respondents were quite concerned about their ability to pay bills. Overall, 69% of the total sample indicated that they found paying bills harder (see Table 11 in Appendix I). Fifty-eight percent of the total sample indicated that they had been unable to pay their bills in the last year.
When examined by race/ethnicity, Blacks and Latinos had the hardest time paying bills, 70% and 77% respectively, compared to 46% of Whites (see Table 10 in Appendix I). One survey respondent shared her thoughts about paying bills asking "What’s a bill? I can’t afford to make a bill. I don’t buy new
things. I only get $137 a month in cash assistance." (#117) A 50-year old African-American woman who was terminated from her job said she had to “borrow money from people to survive.” Men and women equally found paying bills harder, with 69% having reported this hardship. But women were more likely to not have been able to pay their rent 59% than men (54%) not pay other bills. 61% of women indicated they were unable to pay other bills compared to 55% of men. Housing Housing hardship is measured in relation to whether or not people are able to pay their rent, mortgage or utility bills. Nationally 13% of nonelderly people of all income levels and across race/ethnicity experience housing hardship.56 Based on the survey, 18% of the total sample had been evicted in the last year, while 21% had moved because they could not afford to pay their rent. In addition, 34% of the sample had become homeless (see Table 11 in Appendix I). Men were two times more likely to have become homeless in the previous year than women were. When examining all indicators related to housing, Blacks and those identified as “other” were more likely to experience housing vulnerability than any other racial/ethnic group. For example, 19% of Blacks and 22% of those identified as other had been evicted in the previous year, compared to 18% of Latinos and 7% of Whites (see Table 10 in Appendix I). Blacks and others were more likely to take in boarders to help them pay the rent, 7% and 11%, respectively. These two groups also moved in with others at the same rate, with 22% of each having done so. Finally, more Blacks and others became homeless,
56 Ibid, p. 3.
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42% and 44%, respectively, when compared to 20% of Latinos and 39% of Whites.
APPENDIX A
POLICY RECOMMENDATIONS
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POLICY RECOMMENDATIONS FOR NEW YORK’S PUBLIC HEALTH INSURANCE PROGRAMS
Prepared by Children's Defense Fund-New York and Citizen Action of New York
For The New York State Scholar Practitioner Team INCREASE ELIGIBILITY • Eligibility should be increased to ensure universal access. This can be
achieved through using a sliding fee scale on the Child Health Plus B model, with premiums based on family income.
• Adults should have the same eligibility as children. STREAMLINE ENROLLMENT • Eliminate documentation requirements. • Eliminate the face-to-face requirement. • Simplify the application. • Provide immediate access to care through “presumptive eligibility.” • Eliminate the assets limits in community Medicaid (there are no asset limits in
Family Health Plus or Child Health Plus). RESTRUCTURE RENEWAL/RECERTIFICATION PROCESS • Eliminate documentation requirements. • Implement the elimination of face-to-face requirement for Medicaid and Child
Health Plus A. • Obtain federal waiver to allow bi-annual renewals. • Ensure seamless transition between programs. • Create simplified renewal form. OUTREACH/PUBLIC EDUCATION
• Expand culturally and linguistically appropriate outreach and enrollment efforts.
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POLICY RECOMMENDATIONS FOR CHILDCARE57
Ensure Quality Care for Children • Develop appropriate supports to assure quality in family childcare homes. • Develop incentives to increase the number of accredited center and family
childcare programs and Head Start programs. • Increase the number of qualified and credentialed providers by eliminating
barriers and providing opportunities for training and technical support and education.
• Recommend uniform standards across childcare and Head Start programs. Increase Access to Care • Develop strategies to take advantage of the new federal option and work with
New York State to expand childcare eligibility to 275% of the federal poverty level for all families.
• Maintain the new ACS childcare fee schedule to keep childcare fees affordable.
• Utilize revised childcare community needs assessment to direct childcare and Head Start expansion.
• Streamline the application and enrollment process. Expand Availability of Care • Develop additional childcare opportunities in communities with the greatest
unmet need. • Coordinate planning and program development efforts with other city
agencies and work to increase full day and non-traditional hour programs for children ages 0 – 12 years old.
• Make every effort to better serve children with special needs, including children with developmental delays or disabilities, children in foster care, and children living in shelters or transitional housing.
57 New York City Administration for Children’s Services, (2001, December). Counting to 10: New Directions in Child Care and Head Start. New York: Administration for Children’s Services. These recommendations were excerpted from the publication. The recommendations were developed through a six-month collaborative process involving the ACS Advisory Board Child Care Sub-Committee childcare, Head Start and private sector funding community, ACS staff, representatives of other city agencies and other stakeholders. The recommendations excerpted are those that address the issues raised during the course of the research by the New York Team of the Scholar-Practitioner Program through the Community Outreach and Research Project.
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Broaden Parent Involvement and Community Engagement • Develop recommendations to enable childcare and Head Start programs to
increase and promote parent involvement and involve childcare and Head Start families in neighborhood-based networks.
• Develop a public awareness and education plan to promote awareness of childcare and Head Start opportunities, eligibility, enrollment, subsidies programs, and fees.
• Develop family and community resource guides and hold community resource fairs to market childcare programs and provide parents with information about available services.
Strengthen Workforce and Sponsoring Agencies • Develop strategies to ensure better access to training and education for Head
Start and childcare staff. • Recommend changes in compensation and benefits to improve recruitment
and retention of family child-care providers, center-based staff, ACS, Head Start and ACD staff; and contract and delegate agency staff.
Promote Program Innovation • Recommend options for developing collaborative programs which bridge
childcare, Head Start, school-age services, after-school programs, universal pre-kindergarten and Early Intervention services.
• Strengthen links with schools to ease the child’s transition from childcare or Head Start programs to school.
Build State-of-the-Art Facilities • Provide incentives to link new housing or commercial real estate development
with the development of childcare facilities and code compliant family childcare homes.
Enhance Child Development and Support Family Functioning • Develop a schedule to create a family partnership support plan for every child
receiving ACS childcare or Head Start services. • Propose options for enhancing on-site or linked family support services in
early childhood and school-age programs. • Maintain ACS role in promoting Child Health Plus, Family Health Plus, and
other health insurance programs. • Develop a plan for Head Start and childcare providers to link to the ACS
neighborhood networks being developed in each community district.
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Maximize Revenue to Broaden the Base of Support • Maximize the use of state, federal, and private funding and tax credits to
increase the availability of quality Head Start and childcare opportunities. Improve ACS Operations • ACS should fully integrate childcare, Head Start, and child welfare functions
into a new ACS strategic plan.
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APPENDIX B
THE NEW YORK SCHOLAR PRACTITIONER TEAM
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THE NEW YORK STATE SCHOLAR PRACTITIONER TEAM
Scholar Practitioner teams of researchers and mentors have worked in five target states (New York, Florida, Wisconsin, Washington State, and Mississippi) since 1999 to fill a critical gap in the availability of local information. Each Scholar Practitioner team has produced state and local research related to devolution to be used by the Initiative’s state lead organization and their community organizations. They have helped communities translate and interpret research findings that can be used to enhance the policy decision-making process. The New York State Scholar Practitioner Team consists of: Ana Aparicio is currently completing her dissertation at the Graduate Center, City University of New York. Her dissertation explores the role that young -- or "second generation" -- Dominicans play in the formation and continual development of community organizations in New York City. Through current and future work, she is interested in examining the ways that youth, immigrants, and the working poor navigate the various political, economic, social, and racialized institutions to construct a sense of "community," "nation," and civic participation in urban settings. Dana-Ain Davis graduated from the Graduate Center, City University of New York in May 2002. She is currently an Assistant Professor of Anthropology at Purchase College, State University of New York. Her research interests include poverty, violence against women, and HIV/AIDS. She conducts work both in the United States and Namibia and is working on a book, based on her dissertation research entitled: Surviving Welfare Reform: Battered Black Women's Struggles. Audrey Jacobs, JD is a consultant who works with not-for-profit organizations. Most recently she has worked with the Federation of Protestant Welfare Agencies. Akemi Kochiyama is a Ph.D. student in anthropology at the Graduate Center, City University of New York. Ms. Kochiyama has extensive experience conducting research in Harlem. Her main focus has been on residential development and the affordable housing crisis. Andrea Queeley is a Ph.D. student in anthropology at the Graduate Center, City University of New York. She has a background in mental health and substance abuse treatment and is planning to do her dissertation research on race and social stratification in Cuba. Beverly Yuen Thompson has a Master's Degree in Women's Studies. She is currently a graduate student at New School University where she is researching globalization and activism.
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Leith Mullings, Ph.D is the Faculty Mentor for the New York State Scholar Practitioner Team. She is Presidential Professor of Anthropology at the Graduate School of the City University of New York. She has directed several participatory research projects in Harlem and her recent books include Stress and Resilience: The Social Context of Reproduction in Central Harlem (with Alaka Wali) and On Our Own Terms: Race Class and Gender in the Lives of African American Women.
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APPENDIX C
COMMUNITY DESCRIPTIONS
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COMMUNITY DESCRIPTIONS East Harlem
116th Street and Lexington Avenue
Overview. The East Harlem area encompasses most of Community District #11 in Manhattan. The geographic boundaries include the area north of 96th Street to 142nd Street, east of Fifth Avenue to the Franklin D. Roosevelt Drive. Randall’s and Ward’s Island are also part of the district. East Harlem is described in the following manner: “Although classified as a ‘poor’ community by many, East Harlem is rich none-the-less in culture, political activity, ideas, ideals, religion, and people to name a few.”
East Harlem is home to several cultural and religious institutions: El Museo Del Barrio, the Museum of the City of New York, the National Black Theater and Julio de Burgos Latin Cultural Center. Religious institutions include the Islamic Cultural Center, St. Nicholas Russian Orthodox Cathedral, Holy Agony R. C. Church, Mt. Carmel R.C. Church, and the Greek Orthodox Church of St. George & St. Demetrious.
Population. According to the 2000 census, there were 117,743 people living in East Harlem, also known as Community District 11, of whom 34,343 were children, aged 18 and under. In 1997, there were 15,531 children per square mile, compared to the Manhattan average of 12,194. According to the 2000 Census, 52% of East Harlem residents describe themselves as of Hispanic origin, 36% as African American, 7% as White, 3% as Asian, and 2% as Other.58 58 Community District Profile, New York City Department of Planning, Fiscal Year 2002. Available: http://www.nyc.gov/html/dcp/html/lucds/mn11lu.html.
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Income and Income Support. In 1999, 35.7% of the households in East Harlem had incomes of less than $10,000 per year. The adult unemployment rate was 11.6% compared with the Manhattan adult unemployment rate of 5.7%. There were 1,433 children born into poor families in 1997 and 10,717 children (32.8%) between the ages of 0 and 17 were receiving public assistance as of 1999. In 1998, 1,328 women and children were participating in the WIC Program.59 At that time, 17,937 residents overall received some sort of public assistance (AFDC, Home Relief), 12,381 residents received Supplemental Security Income, and 12,930 residents received Medicaid assistance. More than 37% of all residents in East Harlem received some form of income support.60
Health Care. The main health care facilities in East Harlem are Mount Sinai Medical Center and the Health and Hospitals Corporation’s (HHC) North General Hospital and Metropolitan Hospital. Also, there are approximately nine Ambulatory Care Centers in East Harlem: Metropolitan Hospital Center Outpatient Department, Mount Sinai Medical Center Outpatient Department, Center for Comprehensive Health Practice, HHC’s East Harlem Health Center, Settlement Health Center, Metropolitan Family Health Center, Metropolitan Health Care Clinic, North General Hospital’s Outpatient Department, and Boriken Neighborhood Health Care Center.
Asthma is a public health issue in East Harlem. The rates are by far the highest in the City. In 1998, there were 693 asthma hospitalizations, at a rate of 20.3 compared with the Manhattan rate of 9.9 and the New York City rate of 7.1. There were 209 acute respiratory infection hospitalizations at a rate of 6.1.61
Childcare. According to an analysis conducted by the Citizens’ Committee for Children, there is a striking need for childcare in East Harlem, though it is not among the twelve New York City neighborhoods with the highest need. According to the most recent figures, in East Harlem the unmet need for children between the ages of 0 and 5 living below 200% of the federal poverty level is 2,297 slots. For children between the ages of 0 and 5 living below 275% of the federal poverty level, the unmet need is 2,539 slots.62 Resources and Community Assets. In examining a community’s infrastructure, its institutions serve as important community resources. In East Harlem, as of 1997, there were 25 Department of Youth and Community 59 Community District Needs, New York City Department of Planning, Fiscal Year 2001, pp. 243-244. 60 Community District Profile, New York City Department of Planning, Fiscal Year 2002. Available: http://www.nyc.gov/html/dcp/html/lucds/mn11lu.html. 61 Community District Needs, Op. Cit., p.169 62 Citizens’ Committee for Children (2000, May). Childcare: The Family Life Issue in New York City. New York: Citizens’ Committee for Children of New York, p.4.
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Development funded programs. In 1999 there were six After School Corporation sites and three settlement houses.63 Among the myriad community assets in East Harlem are the community-based organizations. The not-for-profit sector constitutes an important resource in East Harlem. With individual, foundation, corporate and some government support, these organizations have and continue to provide critically needed services that enhance the lives of many. An example of such organizations includes the East Harlem HIV Care Network—organized since 1991—which demonstrates the importance of collaboration in addressing community needs. The HIV CARE Network is a consortium of agencies and individuals concerned about the provision of services and care to people with HIV/AIDS in East Harlem. The Network aims to improve the availability, accessibility, quality, and coordination of services for people living with and/or affected by HIV/AIDS.
63 Citizens’ Committee for Children (2002). Keeping Track of New York City’s Children. New York: Citizens’ Committee for Children of New York, p. 181
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Central Harlem
125th Street
Overview. Central Harlem, located in northern Manhattan, is often considered to be the mecca of urban African American culture in the United States. Harlem is a predominantly African-American residential community with other ethnic groups comprising 15.5% of the population. Harlem is known as “The Capital of Black America” and one of the most densely populated areas of the city.
The area is an entry point to city-living for migrants from the southern United States as well as those from other countries. Receiving waves of these migrants over time, as a community, Harlem is quite diverse.5 The population of the community is predominantly native-born minorities. However, it also includes growing numbers of recent immigrants from Mexico, the Dominican Republic, Haiti and Africa, as well as multiracial, middle-income residents. The community known as Central Harlem includes Community Board 10 in Manhattan. The geographic boundaries of this community are Central Park on the South and the Harlem River on the north. Morningside, St. Nicholas and Jackie Robinson parks form the district’s western boundary. On the east, Fifth Avenue and Marcus Garvey Park define the district.
Harlem, one of the designated areas of the Upper Manhattan Empowerment Zone has been undergoing rapid transformation. Recently constructed at West 125th Street and Frederick Douglass Boulevard is the 275,000 square foot retail and entertainment complex called Harlem USA. The complex houses national and local retailers including Magic Johnson Theatres, The Disney Store, HMV Records, Old Navy, Modell's Sporting Goods, New York
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Sports Club, Jeepers! and the Chase Manhattan Bank. The project was expected to create 500 permanent jobs and 200 construction jobs, the majority of which were to be targeted for local residents. Chase Manhattan Bank, UMEZ, the Empire State Development Corporation, and the development team--Grid Properties Inc. and the Commonwealth Local Development Corporation--financed the $64 million development project.
These investments have had a mixed impact on the community and its residents. A recent series of articles in The New York Times about 129th Street (between Fifth and Lenox Avenues) laud the revival of the community. . “Not long ago, there were no rules on this block…. The courtyard was a vacant lot where drug dealers ran from the police. Now, the block has experienced unprecedented economic growth; a startling decrease in crime; the ebb of crack; the remaking of welfare; an influx of immigrants; a city drive to redevelop the housing stock under its control; and the rise of neighborhood organizations focused on restoration.”64 However, housing advocates suggest that these changes have resulted in significant declines in affordable housing and that longtime Harlem residents are being forced out of the neighborhood. Population. According to the 2000 census, there were 107,109 people living in Central Harlem, also known as Community District 10 of whom 30,764 were children aged 18 and under. There were 21,922 children per square mile, compared to the Manhattan average of 12,562. According to the 2000 Census, 79% of Central Harlem residents identified themselves as Black Non-Hispanic, 15% identified themselves as Hispanic, 2.5% identified themselves as White Non-Hispanic, and the remainder identified themselves as Asian Pacific Islander, American Indian, Eskimo, Aleut or Other Non-Hispanic.
Income and Income Support. In 1999, 33.4% of the households in Central Harlem had incomes of less than $10,000 per year. The adult unemployment rate was 15.8% compared with the Manhattan adult unemployment rate of 5.7%. There were 1,329 children born into poor families in 1997, and in 1999, 9,540 or 32.7% of children between the ages of 0 and 17 were receiving public assistance. At that time, 1,328 women and children were participating in the WIC Program.65 In 2000, 16,387 residents overall received some sort of public assistance (AFDC, Home Relief), 8,962 residents received Supplemental Security Income, and 11,338 residents received Medicaid
64 Amy Waldman (2001, February 18). In Harlem’s Ravaged Heart, Revival. The New York Times, p. A1. Amy Waldman (2001, February 19). Monday Beneath New Surface, an Undertow. The New York Times, p. A1. Amy Waldman (2001, February 21). Lines That Divide, Times That Bind. The New York Times, p. A1. 65 Community District Needs, Op. Cit., p.221
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assistance. Thirty-four percent of all residents of Central Harlem received some income support.66
Health Care. Founded in 1887, the main health care facility in Central Harlem is Harlem Hospital. A member of the Health and Hospitals Corporation, Harlem Hospital includes a comprehensive Sickle Cell Center, a Tuberculosis clinic that reduced active tuberculosis cases in Harlem by 75 per cent between 1992 and the present. The Asthma Center is one of only six such centers in the United States. The percentage of women receiving prenatal care in Central Harlem remains below 100%. In 1997, 3.9% of women living in Central Harlem received no prenatal care and 7.4% of pregnant women received late prenatal care. Similarly, 13.1% of babies born in Central Harlem were low birth-weight babies.67 Teenage pregnancy remains a concern as well. In 1997, there were 283 births to teen mothers, representing 16.0% of births.68
Asthma is a public health issue in Harlem. Harlem has one of the highest rates in the city. In 1998, there were 424 asthma hospitalizations, at a rate of 13.8 compared with the Manhattan rate of 7.1 and the New York City rate of 6.2. There were 132 acute respiratory infection hospitalizations at a rate of 4.3%.69
Childcare. Central Harlem is one of the twelve neighborhoods in New York City with an extremely high need for childcare. In Central Harlem, the unmet need for children between the ages of 0 and 5 living below 200% of the federal poverty level is 3,555 slots. For children between the ages of 0 and 5 living below 275% of the federal poverty level, the unmet need is 4,003 slots.70
Resources and Community Assets. Numerous community based organizations with national reputations for best practices are located in Harlem—Rheedlen Centers for Children and Families, Harlem United, Abyssinian Development Corporation, and the Upper Manhattan Empowerment Zone. The Church is probably the most important institution in this community. As of 1997, there were 19 Department of Youth and Community Development funded programs. In 1998 there were two YMCA/YWCA/YMHA branches, one After School Corporation site and four settlement houses.71 66 Community District Profile, New York City Department of Planning, Available: http://www.nyc.gov/html/dcp/html/lucds/mn11lu.html 67 See Leith Mullings and Alaka Wali (2000). Stress and Resilience: The Social Context of Reproduction in Central Harlem. New York: Kluwer Academic/Plenum Publishers. 68 Community District Needs, Op. Cit., pp. 167-168 69 Ibid, p.169 70 Citizens” Committee for Children, Op. Cit., p.4 71 Citizens” Committee for Children, Op. Cit., p.181
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There are numerous assets in Central Harlem. Several foundations and government agencies have invested substantial resources over the years supporting not-for-profit organizations. These organizations have helped to change and improve many lives. Examples include the Rheedlen Centers for Children and Families Children’s Zone (HCZ), a seven-year comprehensive community building initiative. Started in 1997, the HCZ has evolved into an “on the ground,” resident-driven initiative that has served more than 2,700 children to date. The HCZ focuses on a 24-block area in Central Harlem, which extends from 116th Street to 123rd Street and from 5th to 8th Avenue. Funded by several major foundations, the goals of the HCZ are to: support families caring for their children; improve elementary educational achievement, increase employment and entrepreneurial activities, stabilize city-owned housing and small private home ownership, improve the physical environment, increase resident leadership and involvement in the community, support positive youth development, and increase the use and availability of technology.
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The Lower East Side
Canal Street
Overview. Manhattan Community District 3 includes the community
known as the Lower East Side or LOISAIDA. The geographic boundaries of Community District 3 are 14th Street on the North, the Bowery to the West, and the East River to the East. The Lower East Side is one of the most diverse communities in New York City, both in population and geographic area. The community has also undergone a process of gentrification with mixed results for its residents. Twenty years ago, derelict tenements were common and the drug trade was rampant on the Lower East Side. In recent years, the drug trade has subsided and commerce in the area has been revitalized. This has led, however, to a significant rise in rents, and as a result, many low-income families who have lived in the area for decades are being displaced.
Population. According to the 2000 U.S. Census, there were 164,407
people living in the community known as the Lower East Side. There were 35,536 children aged 18 and under; and 9,263 were under aged 5. There were 19,264 children per square mile, compared to the Manhattan average of 12,562. According to the 2000 Census, 28% of the residents of Community District 3 identified themselves as White Non-Hispanic, 27% as Hispanic, 35% as Asian Pacific Islander Non-Hispanic, 7% as Black Non-Hispanic, 3% as American Indian, Eskimo Aleut, Non-Hispanic; and less than 1% as Other Non-Hispanic.
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Income and Income Support. In 1999, 25.5% of the households in the Lower East Side had incomes of less than $10,000 per year. The adult unemployment rate was 8.5% compared with the Manhattan adult unemployment rate of 5.7%. There were 1,434 children born into poor families in 1997, while in 1999 4,779 or 14.6% of children between the ages of 0 and 17 were receiving public assistance as of 1999. There were 1,250 women and children participating in the WIC Program as of 1998. In 2000, 8,740 residents overall received some sort of public assistance (AFDC, Home Relief), 13,662 residents received Supplemental Security Income, and 16,012 residents received Medicaid assistance. Approximately 23% of all residents of the Lower East Side received some income support.72
Health Care. There are two major health care institutions in the Lower East Side—Gouverneur Ambulatory Care and Nursing Facility (a member of the Health and Hospitals Corporation)--and New York University Downtown Hospital. Gouverneur provides additional ambulatory care services to the communities of Lower Manhattan at satellite facilities, including Baruch Houses Child Health Clinic, Judson Health Center and Smith Communicare Center. The Roberto Clemente Center provides ambulatory as well as behavioral health care services. Several special programs are part of Gouverneur Hospital—The Asian Bicultural Unit, which provides psychiatry services for members of the Asian community. The Roberto Clement Center offers psychiatric programs designed for the Latino community; and the Sylvia Del Villard Continuing Day Treatment program provides outpatient mental health services to adults in the Latino community. There are five methadone clinics and the Lower Eastside Needle Exchange Program in Community District 3. The Ryan Nena Center is also well-known and highly utilized by the Latino population.
Childcare. While there is a substantial unmet need for childcare in the Lower East Side, it is not as high as Central or East Harlem. For the Lower East Side the unmet need for children between the ages of 0 and 5 living below 200% of the federal poverty level is 1,195 slots. For children between the ages of 0 and 5 living below 275% of the federal poverty level the unmet need is 1,590 slots.73
Resources and Community Assets. In the Lower East Side, there were 21 Department of Youth and Community Development funded programs as of 1998. In 1999 there were two YMCA/YWCA/YMHA branches, five After School Corporation sites, and four settlement houses.74 In 2000, there were 25 food pantries, 3 Tier II shelters, and no income support centers. The Lower East Side has numerous community assets. Of particular note is the strong settlement 72 Community District Profile, New York City Department of Planning,. Available: http://www.nyc.gov/html/dcp/html/lucds/mn3lu.html. 73 Citizens’ Committee for Children, Op. Cit., p.4. 74 Citizens” Committee for Children, Op. Cit., p.174
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house tradition. The Lower East Side includes four settlement houses—Grand Street Settlement, Henry Street Settlement, University Settlement, and Hamilton-Madison House.
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APPENDIX D
FOCUS GROUP QUESTIONS
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FOCUS GROUP QUESTIONS
HEALTH COVERAGE QUESTIONS 1. What do you do when you get sick
Where do people in your home go when they get sick? (For bi-lingual or non-English speaking people only) Are there interpreters provided to you?
1. Do you have health insurance? 2. Who is your health care provider? 3. Did you have Medicaid or CHIP? Did you ever lose it? Why? Do you certify every year? Did you know that you had to re-enroll every year? 5. Have your benefits been interrupted over the past two years? Why?
What was done to reactivate them?
6. Have you encountered any barriers when trying to enroll in CHIP? Is there any reason you would not like to have Medicare or CHIP?
Do you know what the asset test is? CHILD CARE QUESTIONS 1. Do you have children under the age of 14 living with you? 2. What happens to your children who are under age 14 when you have to leave
your home for a significant period of time, like if you have to go to work, or to an appointment?
3. Do you pay someone to care for your child(ren) out of pocket or with
vouchers? Are they friends, family or formal day care providers? For those of you who use friends or family are you comfortable with them? Do you have any feelings about leaving your child at a child care center? What do you think about or consider when trying to figure out who to leave your children with?
4. What do you think of your child care provider? 5. For those of you not using child care for children under 14, what prevents you
from accessing child care? 6. Has any one told you about subsidized child care or child care vouchers?
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TANF QUESTIONS 1. Did you know there were changes in the welfare laws in 1996?
How would describe those changes? Have they impacted you at all?
2. Did you know there were changes in the immigration laws?
How would you describe those changes? Have they impacted you at all?
3. Have you ever been to the welfare office?
If so, when? What has your experience been like? 4. Have you been referred to a welfare-to-work assignment?
Did they provide you with child care vouchers/subsidies/information. 5. Have you ever heard of CHIP?
Are you enrolled? If not, why not?
6. Were you told that you could still get Medicaid even if you lost your public
assistance? (Who told you?) Were you told that you could still get food stamps even if you lost your public assistance? (Who told you? How did you know?)
7. Have you faced any difficulty since the changes in welfare?
What were they and what have you been doing to get what you needed? Has anyone helped you through this process.
8. What do you think needs to be done to make childcare and healthcare more
available to everyone?
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APPENDIX E
INFORMED CONSENT
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APPENDIX F
FOCUS GROUP PARTICIPANT SUMMARY
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FOCUS GROUP PARTICIPANT SUMMARY
A total of 33 community residents attended the focus groups. Below are overviews for each focus group conducted: ! The Maternal Infant and Reproductive Health Program organized the first
focus group. Five women ranging in age from 18 - 55 participated in the group. Most of the focus group members had children and were concerned about two issues: child health care and punitive measures inherent in welfare reform.
! A program coordinator of the Maternal Infant and Reproductive Health
Program organized the second focus group. There were three participants in this focus group ranging in age from 24 to 35. Two were female and one was a male. All three participants were homeless due to increased housing costs, in one case the consequence of gentrification, and all were living in a homeless shelter.
! The third focus group consisted of students in the summer English as a
Second Language class at Union Settlement. A total of six participants attended: Four were men and 2 were women. The meeting was held in the computer lab where the ESL class had just finished. This focus group was conducted in Spanish. The participants were adult immigrants from Latin America, primarily from Mexico and the Dominican Republic. Many of them would not qualify for public assistance or other programs due to their immigration status. The majority of participants held steady, though low paying jobs. Those with families in their country of origin sent remittances in excess of $300 per month.
! The fourth focus group was held at Harlem Congregations for Community
Improvement's (HCCI) Family Life Center. Ten women participated in this focus group, ranging in age from 20 to 50. The focus group consisted entirely of English speakers. Most of the participants were in HCCI's career center. Participants spoke candidly about their experiences with public assistance, childcare, and access to health care. Other issues addressed were women’s health, child abuse and maltreatment, and employment.
! The fifth focus group was with participants whose children attend Union
Settlement's Leggett Childcare Center. Although five women – all mothers whose children attend the Childcare Center – were expected, only two arrived and participated in the focus group. One participant was a 38 year-old African American woman. She lived in a household of seven people, five of whom were children under age 18. The woman was employed and her wages placed her above eligibility requirements for public assistance. The second participant was a 37 year-old African immigrant woman, residing in Manhattan. Although she had two children, only one lived with her. The
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other child lived in her country of origin. This focus group participant was unemployed. She receives childcare vouchers and WIC. Health coverage for her child was lost due to an administrative error.
! The final focus group was held at the Lower East Side Family Union (LESFU)
and was attended by seven women. They ranged in age from 20 to 55 years. The focus group consisted of English speakers, and one participant whose primary language was Spanish. This participant received interpretation through a LESFU staff person. The participants all accessed services from LESFU. At least two women indicated that they had issues with substance abuse and had completed substance abuse treatment programs.
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APPENDIX G
FOCUS GROUP DEMOGRAPHIC SUMMARY FORM
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FOCUS GROUP DEMOGRAPHIC SUMMARY FORM
Focus Group Participant, please help us with our research about the changes in laws concerning public assistance, health care, and immigration. We want to better understand how these laws have affected your life and that of your children. Please take a few minutes to answer the questions below. Your answers will be confidential and will not be shared with any government or private agency. 1. AGE ______________________ 2. CITIZENSHIP STATUS ! Immigrant ! U.S. Born 3. RACE/ETHNICITY (CHECK ALL THAT APPLY) ! African-American ! Caribbean (Please Specify)_________________ ! White ! Puerto Rican ! Dominican ! Mexican ! Asian/Pacific Islander ______________ ! African ! Other ____________________ 4. QUESTIONS ABOUT YOUR HOUSEHOLD 4a. In which County do you live (Check One) ! Brooklyn ! Manhattan ! Bronx ! Queens ! Staten Island 4b. Do you live in a house or an apartment (Circle One) 4b1. Do you own or rent (Circle one) 4b2. Are you the primary tenant or do you live with someone (Circle one) 4c. How many adults live with you? ___________ 4d. How many children live with you who are under 18? ___________ 4e. How many people live in your household? ___________ 4f. How many children are related to you? ___________ 4g. What is your household income (Check one) ! Under $5,000 ! $5001-9,999 ! $10,000-14,999 ! $15,000-19,999 ! $20,000 or more
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5. QUESTIONS ABOUT YOUR EDUCATION 5a. Do you have a high school diploma or GED? Yes___ No___ 5b. Do you have a college degree? Yes___ No___ 5c. Are you currently in school? Yes___ No___ 5c1. If yes, do you go (Circle one) F/T P/T 5d. Are you currently participating in a job-training program? Yes___ No___ 5e. Are you in a welfare-to-work program? Yes___ No___ 6. QUESTIONS ABOUT YOUR EMPLOYMENT 6a. Do you work Yes___ No__ 6a1. If yes, do you work (Circle one) F/T P/T 7. QUESTIONS ABOUT YOUR ENTITLEMENTS 7a. Do our receive any of the following: (Check all that apply): ! Public Assistance ! Food Stamps ! Childcare Vouchers ! Subsidized Childcare ! SSI ! WIC ! Housing Subsidy 7b. Was there a time when your checks stopped coming Yes___ No___ 7b1 If so, for how long? ________________ 7c. Define sanction 7d. Have any of your benefits been reduced in the last year? Yes___ No___ 8. QUESTIONS ABOUT YOUR HEALTH INSURANCE 8a. Do you have health insurance? Yes___ No___ 8a1. Which type (Pick One) ! Private ! Fee for service ! Managed Care ! Medicaid 8b. How many children do you have? ________________ 8c. Do all of your children have insurance? Yes___ No___ 8d. Do any of your children have Child Health Plus? Yes___ No___ 8d1. How many of your children have Child Health Plus ________________ 8d2. How many of your children have Medicaid? ________________ 8e. How many times in the last 12 months have you gone to emergency room for your self, your children and any adult that lives in your household? ________________ 8e1. Name the place that you went to ________________ 8f. Give examples of health insurance that people have
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APPENDIX H
JOB CENTER QUESTIONNAIRE
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APPENDIX I
TABLES
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Table 1. Job Search and Work Experience Program Participation by Race/Ethnicity Black Latino White
TOTAL NUMBER 36 24 4
In Job Search 39.6 41.7 0
In WEP 30.8 21.7 0
Type of WEP work
Picked up garbage in street/park
24.1 30.8 0
Secretary/office 27.6 30.8 0
CBO 6.9 7.7 0
Other 34.5 30.8 0
Learned new skills at WEP site
31.0 38.5 0
Placement lead to Job 6.9 7.7 0
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Table 2. Employment Status and Reasons for being unemployed by Gender
Women Men Total Sample
TOTAL NUMBER 113 82 195
Employed 10.6 4.9 8.2
If unemployed, have you been employed in last five years
59.6 61.3 60.3
If unemployed, why? * not mutually exclusive
Language barrier 4.9 0 4.9
No childcare 14.8 2.5 9.4
Prefer to be at home 11.9 1.3 7.3
Pregnant 7.9 0 4.5
Domestic Violence 8.9 0 5.0
Mental/Physical health issue 36.6 34.6 35.7
Not enough job skills 16.8 10.3 13.9
Can’t find any job 33.6 44.8 38.5
Can’t find a job that pays enough
18.8 19.2 19.5
Other 23.7 33.3 27.9
Does other type of work 30.3 29.5 29.9
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Table 3. Employment status, Reasons for being unemployed, and Personal Income by Race/Ethnicity
Employment Black Latino White Other
TOTAL NUMBER 102 54 11 9
Employed 6.4 11.5 15.4 0
If unemployed, why? * not mutually exclusive
No childcare 8.8 11 18 0 Prefer to be at home 5.9 13 0 0 Pregnant 4 7.4 0 0 Domestic Violence 3.4 3.7 9.1 0 Mental/Physical health issue 29.4 38.8 63.6 44.4 Not enough job skills 15.7 14.8 9.1 0 Can’t find any job 41.2 37.0 18.2 33.3 Can’t find a job that pays enough 14.7 24.0 9.1 22.2
Other 28.4 24.0 45.5 33.3
Does other types of work 30.5 35.1 15.4 22.2
PERSONAL INCOME
TOTAL NUMBER 109 60 11 9
Under 5K 76.7 76.3 41.7 57.1
5-10K 5.8 8.5 41.7 28.6
10-15K 4.9 5.1 0 0
15-20K 3.9 3.4 0 0
Over 20K 0 3.4 16.7 14.3
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Table 4. Benefit Reductions and Sanctions by Race/Ethnicity
Benefits Black Latino White Other
TOTAL NUMBER 109 61 13 9
Receive benefits 59.6 68.9 46.2 66.7
If receive, which benefits? * not mutually exclusive
64 42 6 6
Public Assistance 76.9 71.4 66.7 50
Food Stamps 92.2 95.2 100 100
Childcare vouchers/subsidies 8 2.4 0 0
SSI 6.3 7.3 20 16.7
Benefits cut in last year 56 55.9 30.8 55.6
Sanctioned in last year 34.3 40.7 30.8 0
If Sanctioned, how did you know
TOTAL NUMBER 36 24 4 0 Letter 52.8 58.3 75.0 0
Phone call 2.8 4.2 0 0
Stopped receiving check 16.7 16.7 0 0
Other 25.0 20.8 25.0 0
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Table 5. Benefit Reductions and Sanctions, by Gender
Benefits Women Men Total Sample
TOTAL NUMBER 113 82 195
Receive benefits 68.1 53.7 62.1
If receive, which benefits? * not mutually exclusive
Public Assistance 80.5 59.1 72.7
Food Stamps 94.7 90.9 93.3
Childcare vouchers/subsidies
6.8 0 6.8
SSI 5.5 13.6 8.5
Benefits cut in last year 59.8 46.3 54.2
Sanctioned in last year 45.5 20.0 34.9
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Table 6. Adult Insurance Coverage and Loss by Race/Ethnicity
Adult Health Care Black Latino White Other
TOTAL NUMBER 109 61 13 9
Have Insurance 60.6 72.1 69.2 55.6
Lost benefits in last two years
43.9 42.4 23.1 66.7
Sanctioned 37.8 41.7 33.3 0 Paperwork/welfare office 28.9 12.5 66.7 16.7 Lost job 13.3 8.3 0 33.3 Don’t know 13.3 16.7 0 50 Other 0 16.7 0 0 TOTAL NUMBER 61 33 4 5 Number times @ hospital or dr. in last year
None 8.3 6.7 0 11.1 1-3 times 51.4 31.7 38.5 44.4 4-6 times 12.8 20.0 15.4 11.1 7-8 times 2.8 6.7 0 11.1 8 or more time 20.2 33.3 38.5 22.2 Chronic condition 44.4 50.8 69.2 55.6
Where did you go last time you went to see a doctor N=105 59 13 8 Emergency room 18.1 15.3 0 12.5 Hospital/Clinic 61.0 57.6 53.8 62.5 Community Clinic 8.6 11.9 15.4 0 Private Doctor 1.9 10.2 15.4 12.5 How did you pay the last time you seen a doctor
Insurance 65.4 75.9 69.2 50.0 Cash 1.9 6.9 0 0 Billed 5.8 0 0 12.5 Didn’t pay 17.3 15.5 7.7 25 *Not all categories add up to 100% due to missing and low percentages in other categories
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Table 7. Adult Insurance Coverage and Loss by Gender
Adult Health Care Women Men Total Sample
TOTAL NUMBER 113 82 195
Have Insurance 69.9 57.3 64.6
Lost benefits in last two years 48.6 35.0 42.9
Number of times at hospital or doctor in last year
None 3.6 12.2 7.2
1-3 times 43.8 43.9 43.8 4-6 times 17.0 12.2 14.9
7-8 times 4.5 3.7 4.1 8 or more times 28.6 23.2 26.3 Chronic Condition 49.1 50.0 49.5 Where did you go last time you went to see a doctor
Emergency room 16.1 17.1 16.5 Hospital/Clinic 59.8 57.9 59.0
Community Clinic 13.4 3.9 18
Private Doctor 5.4 6.6 5.9
How did you pay the last time you seen a doctor
Insurance 71.2 65.3 68.8 Cash 4.5 1.3 3.2 Credit Card 0 1.3 .5 Billed 3.6 4.0 3.8 Borrowed 0 1.3 .5 Didn’t pay 16.2 16.0 16.1
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Table 8. Adult Insurance Coverage and Loss by Site
Adult Health Care Hamilton Dyckman East Harlem
E/W 125-126th St.
Below 34th St
TOTAL NUMBER 39 28 42 8 74
Have Insurance 64.1 75 69 75 56.8
Lost benefits in last two years 56.4 38.5 40.0 37.5 40.5
Number of times at hospital or doctor in last year
None 7.7 7.1 2.4 12.5 9.5
1-3 times 56.4 39.3 31.7 50 47.3
4-6 times 5.1 10.7 26.8 12.5 14.9 7-8 times 5.1 3.6 4.9 0 4.1
8 or more times 20.5 39.3 31.7 25 20.3
Chronic condition 51.3 42.9 64.3 57.1 43.1
Where did you go last time you went to see a doctor
Emergency room 19.4 10.7 2.4 14.3 26.4 Hospital/Clinic 61.1 64.3 732 57.1 48.6 Community Clinic 8.3 10.7 12.2 14.3 8.3 Private Doctor 5.6 14.3 2.4 0 4.2
How did you pay the last time you seen a doctor
Insurance 72.2 75.0 80.5 85.7 55.7 Cash 2.8 7.1 4.9 0 1.4 Credit Card 0 3.6 0 0 0 Billed 2.8 0 0 0 8.6 Borrowed 0 3.6 0 0 0 Didn’t pay 16.7 10.7 9.8 14.3 22.9
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Table 9. Caseworker Contact by Race/Ethnicity Black Latino White Other TOTAL NUMBER 83 55 10 7 Difficult to contact Caseworker 65.6% 71.9% 50% 50% Mean Number of Caseworkers 2.7 2.8 2.8 3.5
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Table. 10. Well being Indicators (2000-2001), by Race/Ethnicity
Black Latino White Other TOTAL NUMBER 108 58 13 9 Food Hardship Could not 45.4% 28.6% 23.1 44.4 Buy food Skipped Meals 40.7 30.4 30.8 44.4 Relied on Community Services for food 42.6 26.8 23.1 33.3 Bill Hardship Paying Bills Harder 70.4 76.8 46.2 33.3 Can’t pay rent 63.0% 51.8 15.4 55.6 Can’t pay other 59.3 64.3 30.8 44.4 Bills Housing Insecurity Evicted 18.5% 17.9% 7.7 22.2 Moved/could Not afford rent 25.0 10.7 15.4 33.3 Moved in w/ others 22.2 17.9 0 22.2 Took in Boarders 7.4 3.6 0 11.1 Became Homeless 41.7 19.6 38.5 44.4
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Table 11. Well being Indicators (2000-2001) by Gender
Women Men Total Sample TOTAL NUMBER 113 74 187 Food Hardship Could not 38.5% 41.3% 39.7 Buy food Skipped Meals 41.3 33.8 38.1
Relied on Community Services for food 33.9 38.3 36.0 Bill Hardship Paying Bills Harder 68.8 68.8 68.8 Can’t pay rent 57.8% 53.8 56.1 Can’t pay other 60.6 55.0 58.2 Bills Housing Insecurity Evicted 15.6% 21.3% 18.0 Moved/could Not afford rent 16.5 27.5 21.2 Moved in w/ others 17.4 22.5 19.6 Took in Boarders 3.7 10.0 6.3 Became Homeless 22.0 51.3 34.3
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i 16
16 All differences presented in the statistical data are actual differences. There were not statistical tests run to determine the significance or validity of the data.