Child Development Clinical Trial
Official title:
Building Wealth and Health Network: A Microfinance/TANF Demonstration Project
The goals of the The Building Wealth and Health Network (The Network) are to develop and
rigorously test an asset building model that will build financial, social and human capital
through asset building, financial education and trauma-informed peer support. Program
components include: 1) Matched savings accounts; 2) Financial literacy classes; and 3) Peer
support groups using the Sanctuary ® trauma-informed approach to social services. This
program is offered in partnership with the Department of Public Welfare of the Commonwealth
of Pennsylvania. The program elements will fulfill work requirements for the program called
temporary Assistance for Needy Families (TANF).
The hypothesis is that the program's combination of services will result in improved
economic security through boosting income, increasing assets, and building a supportive
social network, that then translates to better health outcomes.
Families with young children under age six participating in The Temporary Assistance for
NeedyFamilies Program (TANF) that are deemed "work mandatory" are required to participate in
work-related activities for at least 20 hours per week in order to receive TANF benefits.
However, due to financial hardship, poor health, and exposure to violence and adversity, the
success families achieve through TANF participation can be limited.
In 2013, 45.3 million people lived in poverty in the United States, including over one in
five children under the age of six, yet only 27% of eligible families received Temporary
Assistance for Needy Families (TANF). While child poverty increases the risk of poor health
and developmental delays, many public assistance programs, such as the Supplemental
Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC), and housing subsidies, protect vulnerable children from the
negative effects of poverty. However, it is unclear if TANF has demonstrated significant
improvements in maternal and child wellbeing, in moving families out of poverty, or in fully
preparing low-income families for success in the workforce.
One of the goals of TANF is to provide job skills and education programs to support adults
and their children as they enter the workforce. However, many families experience barriers
to employment, which may prevent them from successfully transitioning off of TANF. This may
be due in part to poor health among those receiving TANF, as approximately one third of TANF
recipients have reported a work-limiting health condition; and almost 43% of TANF recipients
reported multiple types of disability including memory impairment, emotional/mental
limitations, movement limitations, and sensory impairment. In addition to the poor health
and disability reported by TANF participants, they also report alarmingly high rates of
exposure to violence and adversity in their communities and in their family relationships.
For instance, among TANF eligible families, rates of intimate partner violence are as high
as 74% compared to up to 31% in the general community, posing a major barrier to rates of
employment. While exposure to violence in adulthood indicates severe hardship, such exposure
to violence across the lifespan, reaching back into childhood, is also reported at
significantly higher rates among low-income families. Adverse childhood experiences (ACEs)
consisting of physical and emotional abuse and neglect, sexual abuse, and household
dysfunction, such as having a household member in prison, or witnessing domestic violence
are especially prevalent among those receiving TANF. ACEs and violence exposure are closely
linked to work-limiting conditions such as depression, cardiovascular disease, food
insecurity and other health conditions. Exposure to ACEs has been linked to higher rates of
worker absenteeism and stress surrounding work and finances in adulthood, indicating an
association between ACEs and later financial stability. Other related barriers to work are
having a criminal record, or having served time in prison, and among female heads of
household TANF recipients, the prevalence of interactions with the criminal justice system
is quite high compared to other low income populations. Finally, when a parent of a young
child is in prison, it can have detrimental effects on the child's development, which in
turn, demands more attention, time and care by adult caregivers, creating more barriers to
work. Female heads of households who have a criminal history are at greater risk for
reaching the TANF time limit which can exacerbate the barriers of obtaining employment.
Furthermore, children whose parents have a criminal history are at a greater risk of
becoming involved in the criminal justice system and are more likely to exhibit high-risk
behaviors than children in the general population.
The high levels of adversity among TANF recipients and those living in poverty is a
significant concern because adversity impacts physical and mental health, academic
achievement, employment, the development of executive skills such as working memory and
cognitive controls, and parenting of the next generation. Emphasis on job search and work
participation for families without attention to adversity and poor health can be a set up
for failure. Preliminary evidence demonstrates that social support and comprehensive
approaches to social work that build resilience may have strong success in limiting the
negative impacts of exposure to violence and adversity. However, the majority of TANF
programs across the country rarely integrate such approaches, and in many states, TANF
participants that are unable to meet the mandated work requirements, potentially due to poor
health and exposure to violence and adversity, may be more likely to be "sanctioned," either
have their cash benefits reduced, or cut off completely for a duration of time.
Families that receive sanctions are more likely to have significant health barriers to work
participation. Additionally, those that have been sanctioned reported higher rates of
intimate partner violence, and physical and behavioral health problems. Sanctions can then
increase hardships families already face. For instance, compared to families who have not
been sanctioned, families that experience sanction report higher rates of household food
insecurity, utility shut-offs, child hospitalizations, difficulty paying for health care,
homelessness, and disruptions in children's schooling. This is especially problematic as
those who are sanctioned often have young children, putting those children at increased risk
during sensitive developmental phases.
To compound the mental and physical barriers to work and self-sufficiency, TANF-eligible
families, like many low income families, have low financial literacy, poor no credit
history, few or no assets, and are unbanked (having no checking or savings account) or
under-banked (having a bank account, but still primarily relying on alternative financial
services such as check cashing and money orders). In order to supplement meager income,
families may resort to earning income and spending money through the informal economy where
they are paying higher fees for check cashing, paying bills, and acquiring loans. This lack
of access to mainstream financial institutions and activities can be crippling, as savings
and other tangible assets play a critical role in helping shield families from unexpected
income shocks, allowing families to weather periods of economic uncertainty without falling
further into poverty. Savings create a financial foundation, increase economic security, and
can be, over time, invested into education for children. Asset building activities show
improvements in health, greater civic and community involvement, and lower rates in the
intergenerational transfer of poverty. Savings can also reduce the extreme stress that often
accompanies maternal depression. Finally, the positive impacts of savings have held true
even during the recession.
In partnership with the state of Pennsylvania Health and Human Services Department, The
Building Wealth and Health Network (The Network), a randomized, controlled pilot study,
sought to evaluate effectiveness of an intervention to address family hardships associated
with exposure to adversity and violence, social isolation, and low financial capability in
order to help families get on the pathway to self-sufficiency.
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