About CBPR
In the decade since the U.S. welfare system was overhauled in 1996, millions of people have left public assistance and are now working. Most welfare recipients are single mothers and although the number of them on public assistance has dropped, many of them remain vulnerable to mental and physical health problems that are not adequately being addressed in current programs that move people from welfare to work.
Numerous studies over the past decade have demonstrated women receiving welfare have rates of depression, anxiety, and other physical health problems that are two to five times higher than that found in either the general U.S. population of women or other low-income women. These differences in health reflect the high concentration of poverty and racial/ethical minority status of women comprising this group, and represent some of the widest health disparities among women in the United States.
Studies have also documented that 30% of those who enter welfare-to-work programs return to Temporary Assistance to Needy Families, or TANF
http://www.acf.hhs.gov/programs/ofa/, within a year after leaving it because they have difficulty maintaining employment, and one factor driving this is the extremely high prevalence of chronic health conditions in this group. In Florida, studies indicate recidivism is much higher: 55% of TANF clients reapplied for assistance within 18 months of leaving welfare for work.
While studies have clearly documented the severity of health problems in women receiving welfare, however, data indicate these problems are neither being identified nor adequately addressed in current Welfare Transition Programs (WTP). Most critically, no studies investigating how to improve the health of women in these programs exist even though chronic health problems have been shown to limit their ability to secure and maintain employment.
Research aims
In order to address these deficiencies, this study, which is funded by the National Institutes of Health www.nih.gov through the National Institute of Nursing Research www.ninr.nih.gov (NIH/NINR # R01 NR009406-01), has a long-range goal of reducing health disparities in women of lower socioeconomic status and belonging to racial/ethnic minority groups. This is consistent with the goal of the U.S. government to eliminate health disparities, as detailed in the Healthy People 2010 http://www.healthypeople.gov/ initiatives, and outlined in NIH/NINR strategic plans.
The proposed study is innovative in that it is the first to test an intervention aimed at improving the health of women in a welfare-to-work program based on the needs and preferences of the women themselves through community based participatory research. This study, and others conducted by its principal investigator, indicates that women in these programs are enthusiastic about being involved in research partnerships whose intent is to develop sound, evidence-based strategies that can improve their own health as well as that of others who are disadvantaged.\
In order to accomplish its goal, this study will:
- Redesign the health screening instrument currently in use in welfare transition programs in Florida in order to make it culturally relevant, sensitive, and acceptable to women with whom it will be used. This portion of the study, which has already been completed (read preliminary results [here the link should be to the “Research Highlights” page of this site]), was accomplished with the direct involvement of women who were on welfare.
- Test the efficacy among women enrolled in a WTP of a welfare participant-centered health program in a) increasing the rates of voluntary screening, identification, and treatment for chronic health conditions, b) increasing the ability to navigate the Medicaid http://www.cms.hhs.gov/home/medicaid.asp system, c) improving functional and health status over time, and d) increasing employment duration among women with chronic health conditions using a participatory research methodology.
Women who receive this program intervention are expected to exhibit at least: a) 40% higher rates of screening for, identification of, and referral for chronic health conditions, b) 30% greater Medicaid knowledge and skills, c) 8% higher functional status scores and health status scores (based on the Sickness Impact Profile and SF-36 measure respectively), and d) a 20% greater employment duration than those receiving standard care in a WTP.
Study methodology:
The aims of this research will be undertaken though a clinical trial with a target enrollment of 156 participants in each of the intervention and control groups. These participants will be recruited from the Alachua and Bradford county FloridaWorks http://www.floridaworks.org/ career centers and must be women 18 to 60 years old who are currently enrolled in the WTP and not yet employed. It is anticipated that approximately 65% will be African American, 31% Caucasian, and 4% Hispanic. This reflects the current ethnic/racial makeup of the women enrolled in WTPs in North Central Florida and is consistent with recent past samples of this population.
Participants will be screened by a public health nurse at the WTP site for chronic health conditions, ongoing symptoms over the past year, and select mental health conditions. Participants who meet the chronic health condition requirement will be eligible for study enrollment, and if randomized to the intervention group, will be further assessed by a public health nurse at three-month intervals for one year. At these follow-up assessments, the nurse will assist participants with several things to meet their needs, including:
- controlling symptom of existing chronic health conditions
- ensuring access to prescribed medications
- adhering to prescribed treatments
- assessing barriers to follow up care
- communicating with primary care providers
Timeline
