Exam Notes for SW Policy

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Notes for 4 Exams (see text by DiNitto as well)


CHAPTER 1
Politics, Rationalism, Social Welfare

1. Define social welfare policy. (2)
anything a government chooses to do, or not to do, that affects the quality of life or its people.

2. Differentiate the following welfare programs: (4)
public assistance - must be poor, general-revenue funds
social insurance - prevent poverty, entitlement
social services - provide care, counseling, education, etc.

3. Define social welfare policy as a rational approach. (4)
an ideal approach - identify problems, values, alternatives, consequences, cost benefits, choose maximum net values.
Target groups
Nontarget groups, externalities, spillover effects
Comprehensive verses bounded rationality

4. Define social welfare policy as a political approach. (7)
Conflict over nature of problems confronting society
Politics: who gets what, when, and how
Conflict found in human diversity
Task of government is to regulate conflict

5. Define the incremental model - small changes. (9)
Current policies, programs, expenditures are seen as a base
Greater conflict if government begins each year a zero
Uncertainty about consequences of new programs

6. Discuss stages of the policymaking process. (13)
a. Agenda setting - a non issue until publicized
b. Nondecisions - apply pressure to suppress problem emergence
c. Mass Media - deciding what is news and who is newsworthy
d. Budget - OMB, House and Senate Budget Committees, joint Congressional Budget Office, Appropriations committees, hearings, October 1 to Sepember 30
e. Implementation - continuation of policy-making, activities that result from official policy adoption, bureaucracies (proposing legislation, writing rules, deciding specific cases to apply rules)

7. Discuss the impact of public opinion on social welfare policy. (17)
Gallup Poll
Politicians monitor

8. Discuss giving by Americans. (21)
One half adults volunteering over 4 hours per week
1997 nearly $143 billion given
contributing households give 2%
Peace Corps, AmeriCorps

9. Discuss political ideology and social welfare. (22)
Conservative - defender of status quo, state over federal action
Liberal - more government action to meet needs
Democrats vs Republicans
Family values, moral majority, traditional values, religious right

10. Discuss PACs and social welfare. (26)
Poor represented by proxies (NASW, churches, labor)
Hard money - money given to candidates directly by individuals and corporations (limited)
Soft money - money given to political party committees (unlimited)


CHAPTER 2
Government and Social Welfare


Discuss the Elizabethan Poor Laws.

Mutual aid - informal system between neighbors
14th and 15th centuries - 1349 black death, King Edward III (Statute of Laborers)
Poor Law of 1601 - 1st providing of social welfare benefits,
A means of controlling the poor from disrupting society
Deserving vs. nondeserving poor - outdoor (in home) and indoor (almshouses) plus workhouses (menial work in exchange for necessities of life)
Local jurisdiction (parishes) local residents only

Discuss early relief in the United States.

American colonists adoption of Elizabethan system
Warning out - urging poor to move on to other towns and
Passing on - escorting poor back to home area
4 colonial methods: auctioning to families for care, supervision by a couple, outdoor relief, almshouses
Scientific charity (1870s) Charity Organization Societies (COS) - forerunner of today's social work

Discuss the great depression and New Deal.

1870-1920 private groups, settlement houses, churches, political machines and bosses provided assistance
Local and state governments develop a smattering of mother's aid, mothers pension, aged, blind, and disabled, workman's compensation.
Great Depression and stock market crash in October 1929 (one out of 4 unemployed, one in 6 on welfare)
Change in American attitudes toward the poor--poverty beyond one's control
Social Security Act of 1935, ADC, elderly, blind, job programs, unemployment compensation, vocational education, etc.

Discuss the Great Society and War on Poverty.

Greater dichotomy between haves and have nots, high minority poverty
War on Poverty (Economic Opportunity Act of 1964)--model cities, CAP, Head Start, Food Stamps, Medicaid, Medicare
1970s dismantling agencies of War on Poverty to clean up welfare mess, FAP, SSI, social services for children and aged.


Explain factors that have contributed toward the expansion of social welfare.
Rural-to-urban migration (late 1800s and early 1900s) - industrial revolution, agrarian to industrial society, changes in family roots

Residency requirements eliminated (Supreme Court in 1969 declared unconstitutional) - violated one's rights to equal protections under the law and right to travel

Welfare rights movement in the 1960s - poor treatment led to demonstrations, sit-ins, riots during 1964-68 (Kerner Report - Commission on Civil Disobedience)

Cost-of-living adjustments (COLAs) or indexing in the 1970s to keep SS, SSI, Food Stamps in line with inflation

Graying of America - increase in elderly percentage (over 65) - 4% early 1900s, 13% today, 17% in 2020 - today SS and Medicare the largest of social welfare programs

Increase in Single-Parent Families - from 1950 to 1975 female-headed households doubled to over 7 million with 70% including children - 1997 90% of single-parent families headed by women

Discuss finances in the welfare state.

Today federal funds account for 68% public assistance and 82% social insurance spending
Funding the federal government in 2000 - 48% individual income taxes, 34% social insurance (82% total), corporate (10%)
Income tax the primary means of financing state government
Sales taxes finance state and local (city, county) governments
Property taxes fund schools
Corporate welfare - businesses receive government assistance from contracts, subsidies, tax deductions.
Poor pay the most income percentage for state and local the rich in federal taxes

Discuss the Legacy of "Reagonomics".

A disillusionment through two decades of welfare
Philosophy of Reagan administration included: 1) Keep public spending on welfare to a minimum, 2) Minimize federal role in public assistance, 3) only truly needy should be helped, 4) assistance on a short term only

Explain supply-side economics

Keynesian economics focused on demand side - increase government spending to boost employment which increases inflation as a consequence and vice versa
Reagan economics focused on supply-side economics - reduce government spending, give tax relief to encourage investment, reduce federal regulations that cost business, encourage slower growth of nation's money supply.
Misery index is the combined unemployment rate with the inflation rate
Trickle-down approach to the economy - reduce taxes and regulations on businesses and the affluent to encourage investment so as to provide jobs for the working class and poor

Describe ways for helping the truly needy.

Reagan's social safety net in reducing federal spending included leaving intact SS and Medicare but not programs such as AFDC, food stamps - thus, removing many
Block grants were packaged with fewer strings attached to state and local governments for health, welfare, education, law enforcement - contrast to less-preferred categorical grants

Describe Bush's states as laboratories.

To counter harshness of Reaganomics, Bush spoke of kinder and gentler America - seeing states as laboratories, encouraging innovative programs for the poor (i.e., Wisconsin)

Discuss privatization of public services.

Private sector provides social welfare programs through governmental contracts (i.e., prisons, health care, mental health)
But many private providers are actually quasi-public or semiprivate--rely on government funds (i.e., Medicare can Medicaid funds paying for health care, HUD providing FHA loans for housing, CMHCs established with public funds, Amtrack, etc.)

Discuss the Bill Clinton years.

Under Reagan and Bush administrations (1980-1993) the federal debt grew larger than in any previous administrations.
The government spends about 11% of its budget on interest on the money it owes the public.
Clinton years have involved battles over the budget - spending and balancing
The president was allowed some leeway on the line-item veto
The president's Health Security Act failed
Welfare reform was achieved

Is it necessary to balance the budget?

Is balancing the federal budget the same as balancing the household budget?
Why is balancing the budget a concern for many?


CHAPTER 3
Defining Poverty

What is poverty?

A political activity
Poverty as a political activity for 40 years (tying together problems into a single “bedrock” problem) i.e., slum housing, juvenile delinquency, unemployment, illiteracy.

Define poverty as deprivation (an absolute measure).

Insufficiency in food, housing, clothing, medical care, etc.
Deprived: a standard, minimum, that one lives below
Poverty level, poverty line, poverty index, poverty threshold
1st calculated in 1964 by Millie Orshansky for SSA
low-cost, nutritious food budget for family of 4
multiply X 3
1960-$3,022; 1970-$3,968; 1980- $8,414; 1997-$16,400
Government survey of 57,000 (94) was 14.5%; 50K (95)% was 13.8%
35.6 million in 1997 (13.3% individuals and 10.3% families)
Poverty gap/average income deficit: would take $6,602 to bring each family to poverty threshold (96)
Problems with government definition:
Only cash income is considered; excludes in-kind benefits
Underreporting of incomes
Does not consider regional differences
Styles of living
Family assets are not considered
Status of individuals or families (students or retirees)
Special problems or hardships (illness, debts)
Outdated 1/ - more like 1/5

Describe computing in-kind benefits.

Market-value approach - cost to a private consumer to purchase goods or services (i.e., food stamps, public housing, health care)
Cash equivalent approach - cash value that recipients place on the in-kind benefits they receive (what it would cost a poor family not receiving benefits to purchase same goods and services)
Market-value preferred over cash equivalent approach because recipients prefer cash over in-kind benefits

Who are the poor? (73)

More whites than blacks (16.5 m), but blacks (9.1M) are 3X more likely to be poor
Families headed by women with no husband much more likely to be poor - 31.6% to 5.2%
14.1 million children under 18 (19.9% of age group) - 16.1% white, 36.8% Hispanic, 37.2% black
Poverty for Americans 65 and older have dropped (24.6% in 1959 to 10.5% in 1997)
Urban (18.8%) and Rural (15.9%)
More poverty in the South than other areas

Describe poverty as inequality.

Inequality in the distribution of income
Relative or perceived deprivation - perceived to have less income or material possessions than other Americans
Poorest 1/5 of U.S. families receive less than 5% of all family personal income; highest 1/5 receive 47.2%; top 5% receive 20.7% (1997) (p77)

Explain why the poor are poor.

Human capital theory - poor are poor because their economic productivity is low (poor missing knowledge, skills, training, education to sell employers in the market)
Absence from the labor force is the single largest source of poverty.
Many poor are elderly, children, disabled, and those discriminated against
Equality of opportunity (Founding Fathers) is not absolute equality but removal of obstacles to upward mobility (i.e., discrimination)

Define poverty as culture.

Poverty as a way-of-life, passed from one generation to the next
Present-orientedness, vulnerable to misfortunes (i.e., illness, layoffs), psychologically don’t plan for the future
Patterns of poverty - anthropological causes (i.e., rural southern heritage)
Questions:
Are the poor undereducated, unskilled, poorly motivated,
and delinquent because they are poor? Or
Are they poor because they are undereducated, unskilled,
poorly motivated, and delinquent?
Assumptions/strategies:
If poor are no different that other Americans, then
emphasize opportunity for individuals plus environmental
changes (i.e., job-training, good schools); provide the
means to achieve.

If one believes in the culture of poverty, then interrupt the
transmission of lower-class cultural values from generation to generation (Head Start, day care, preschool programs, orphanages)

Discuss poverty as exploitation

Poverty is maintained by upper classes to make their own lives more pleasant
Lower class provides a cheap choice of labor
Lower class buy used items, day-old-bread, loaned money by loan sharks, provide focal points for philanthropic activities
Upside-down welfare state - for the poor government assistance is welfare, for the upper classes good business.
Welfare programs expanded in times of social, political, economic unrest; reduced during times of stability (i.e., force to work)

Discuss poverty as structure

Institutional discrimination (structural) focus - practices that are deeply embedded in schools, the criminal justice system, other organizations that serve gatekeeper functions in society
Regional poverty in areas where unemployment is high - areas passed by for economic development
Abandonment of areas of the city to the poor with high unemployment, crime, drugs, teen pregnancy, etc.

Questions:
Do we focus the attention of programs to change personal characteristics of the poor? Or
Do we address structural issues in the society itself - develop or change social institutions, change social policies (i.e., change from housing in ghetto areas to housing in non-ghetto areas, national service program for all youth to being them into society mainstream)?

Who are the homeless?

Two groups have traditionally comprised the homeless: 1) alcoholics and drug addicts, and 2) mentally ill who have been deinstitutionalized.
Unaccompanied men still comprise most of the homeless;
15% of homeless are children; 25-40 % are families.
Estimates place 735,000 homeless on any given day.

Affordable housing

Many low-income persons spend 1/2 their income for rent.
1/3 of renters in every state can't afford the prices charged for a one-bedroom apartment.
Two forms of housing for low-income families:
Public housing - 1.3 million households, with median annual income of $6,420, and $169 paid for rent each month (1996).
Subsidized rental assistance (section 8) - vouchers to rent privately owned or subsidized housing (1.4 million families)

Does welfare cause poverty?

Murray and Guilder


CHAPTER 4
Preventing Poverty

Preventing poverty through compulsory savings

Social insurance - employers and employees are compelled to purchase insurance for forces beyond their control: loss of job, disability, death of breadwinner, advanced age.

Today the tax rate is 7.65% for both employer and employee to add up to 15.3%--the second largest source of income for the federal government.

The Social Security Act of 1935

Early beginnings from Germany in 1889 (Bismarck)
US government began a federal program for retirees in 1920
Townsend Plan was promoted during the depression - popular but expensive ($200 per month from taxes on banks)
Social Security Act established basic policy for social welfare
in the United States
Basic social insurance programs include:

OSAI - old age and survivors insurance
DI - disability insurance
HI - health insurance (Medicare, 1965)
UC - unemployment compensation

Public assistance programs include:

SSI - supplemental security income
TANF - temporary aid for needy families
Medicaid - federal-state medical assistance


Social service programs include:

Child Welfare (i.e., IV-E)
Maternal and child health
Additional services to vulnerable groups

Passage of Social Security Act influenced by several factors:
increased inability for families to care for the elderly
economic insecurities from the great depression
political movements on the right (Townsend) and left socialism) than threatened social order

3. Social Security as the world's largest social welfare program

In 1997 145 million workers (96% of workforce) and employers paid Social Security taxes
44 million people collected benefits
$30 billion per month was spend
Social Security taxes second largest source of income for the federal government
A regressive tax program:
Taxes levied only against wages not other sources of income
There is a fixed amount of earnings which are taxed - over this amount there are no taxes
Social Security taxes don't account for number of dependents, medical expenses, etc.
Benefits are figured more generously for those who earned less
Retirees in higher income brackets must now pay taxes on part of their social security

4. Evolution of strategy of Social Security

Original strategy of the Social Security Acts of 1935 was to create a trust fund with a reserve built from insurance premiums (SS taxes); general tax revenue would not be used.
Pressure to pump more money into the economy because of the depression helped lead to abandonment of self-financing plan in 1939
Pressure over the years to increase benefits while keeping the tax low led to the government putting the system on the federal government's budget
COLAs were adopted in 1972
To receive SS recipients must have paid into the system
1977 benefits were reduced and taxes increased
The retirement age has been raised to 67
More worker groups were added to the system over the years (i.e., federal employees and members of Congress)
Today, OASI and DI funds are seen as adequate in terms of annual coverage, but HI funds are not enough.
But, people are retiring at a rate greater than workers paying into the system (fertility rate decrease)--2021 OASDI payments will exceed contributions plus interest
Dependency ratio is growing worse--today 3 workers to 1 recipient--in the future 2 workers to 1 recipient
intergenerational compact - current generation of workers support prior generation in retirement
OASDHI has improved the financial status of older people over the years.
Elderly minority groups tend to experience shorter life spans resulting in less access to retirement benefits

5. Future funding of OASDHI

Increase the payroll tax - yet, there is little support to do so in the near future
Invest SS funds into the market
Allow more private investment in companion with or alternative to SS
Tax benefits
Delay COLAs
Reduce benefits to widows while spouses are living
Include more years of work

6. UNEMPLOYMENT COMPENSATION

UC was part of the original SS Act - compel employers to contribute to a trust fund to help employees in case of job loss.
Federal government requires employers to pay into state administered unemployment insurance programs that meet federal standards
Persons must show they are willing, able, and ready to work - register with the US Employment service and actively seek work.
The federal government maintains a fund to bail out any state trust fund that becomes exhausted.
Recipients are limited to 26 weeks of unemployment payments.

7. Determining unemployment

U.S. Department of Labor monthly estimates the percentage of the workforce out of work and actively seeking jobs.
Rate is based on a survey of 50,000 households and includes those 16 years of age and older.
Many are not counted because they have given up trying to find a job - discouraged workers.
The under-employed are not counted since they are employed, but work at jobs for which they are overqualified.
Unemployment for African Americans is at least 2X as that for whites. Hispanics do better than African Americans.
Teenage unemployment is 3X that of the general population.
Teenage unemployment among African Americans can be 40% or better.

Workers' Compensation

The labor department of each state administers WC.
Programs vary by state, but each provides cash payments and medical benefits to workers who sustain injuries on the job or develop job-related diseases.
WC helps with short-term disability and longer-term partial disability.
Dependents of workers killed in job-related accidents are entitled to benefits--some states also provide for widowers.
Most employers insure their workers through a private insurance company; others self-insure; still others are insured by the state.

CHAPTER 5
Helping the Deserving Poor: Aged, Blind, Disabled

Early public assistance for the deserving poor.

Prior to 1935 many states had public assistance programs to assist the elderly poor and blind.
Disability policies tended to lag behind.
Adult categorical public assistance programs of the Social Security Act of 1935 included OAA, AB, APTD (1950).

Federalizing public assistance: SSI

Nixon (1972) wanted to clean up the welfare mess - proposed the guaranteed annual income plan to replace OAA, AB, APTD, and AFDC. (Family Assistance Plan)
Plan failed: liberals said too little and conservatives said too much in terms of benefits.
AFDC was not reformed but OAA, AB, APTD were federalized into Supplemental Security Income (SSI) plan.
SSI is a means tested program; one can receive SSI in addition to other Social Security benefits.
SSI is a plan of last resort - all other benefits exhausted before able to qualify.
Countable resources can't exceed $2000 for an individual and $3000 for a couple.
Countable income includes earning from work, Social Security payments, cash benefits, and interest income - $520 and $771.
A formula is followed to determine SSI payments (see text 137-8).
For disability determination, the process is the same for both Social Security Disability Insurance (SSDI) and SSI.
The determination process usually takes months because of the backlog of cases. Many are denied initially.
Average SSI payments total $277 per month for the elderly, blind $390, and disabled $380 (1998).
Children are a fast-growing segment of the program with the largest group due to mental retardation (44%).

Some political hot spots of SSI.

Coverage for immigrants who are not citizens.
Disabilities of alcoholism and drug abuse (eliminated in 1996)
Children with behavioral and mental disorders.

Vocational rehabilitation for those with disabilities.

Early VR services were provided in 1916 in Massachusetts and by the US government in 1920 for disabled and disabled veterans of WWI.
Federal government provides the majority of funding for VR programs but each state operates its own program according to federal guidelines.
Each applicant is provided a VR counselor who develops an individualized written rehabilitation plan.
Creaming is the practice of accepting applicants who can achieve rehabilitation more easily.
Though it is the nation's largest rehabilitation program, many who want or need assistance will never be served.

Civil rights for people with disabilities

Deinstitutionalization came in 1972 from Supreme Court (Wyatt v. Stickney) - residence in an institution must be the least restrictive setting.
Normalization provides the opportunity to live like other citizens - architectural barriers, transportation, etc.
Independent living centers are facilities that train the handicapped how to care for and advocate for themselves.
Legislation in support of the handicapped include: Architectural Barriers Act of 1968, Title V of the Rehabilitation Act of 1973, American Disabilities Act of 1990

Disabilities policy for children

Inclusion or mainstreaming allows children with disabilities to receive their education in regular public school programs whenever possible.
An Individual Education Plan (IEP) must be developed for each child with parents having the right to participate.
Smaller, poor school systems often have problems with the mainstreaming process.

General Assistance: state and community response to welfare.

GA predates the New Deal programs.
GA is funded and administered by state and/or local governmental units.
The purpose of GA is to fill gaps left by other welfare programs. TANF and SSI recipients are not eligible for GA.

Federalism and social welfare

TANF (formerly AFDC) is now a block grant program from the federal government, with states having more discretion over program rules.
SSI and food stamps are federal programs.
General assistance is either a state or local program.
Medicaid continues to be an entitlement program.
Following the New Deal, the trend was more toward greater centralization, but currently the trend is in the reverse.

CHAPTER 6
Ending Welfare as We Knew It: Temporary Assistance for Needy Families

From mothers' aid to AFDC

Early programs intended to help children whose fathers were deceased, disabled, or absent through divorce or desertion were called mothers' aid or mothers' pensions.
Aid to Dependent Children (ADC), developed in 1935, was to provide short-term assistance to needy children - but, the focus was to help mothers on behalf of their children.
The most stinging accusation of ADC was its contribution to fathers deserting their families--an able-bodied but unemployed father at home meant the family could not receive ADC.
Changes were made to alleviate the problem: ADC-Unemployed Parent (UP) (1961), later became AFDC (1962), later AFDC-UP (1967) - ruled unconstitutional in 1979 because unemployed mothers were not included.
Years later, researchers concluded that the impacts of welfare on family structure were very modest.
The work ethic in the early days brought about man-in-the-house rules and midnight raids to find able-bodied men at home; Supreme Court ruled in 1968 that the method was not appropriate for denying children public assistance.

Trying to make parents pay.

Several approaches have be implemented to increase child support collections: Child Support Enforcement (CSE) (1984); establishment of the Office of Child Support Enforcement (1975); Federal Parent Locator Service.
States have established guidelines for child support payments that non-custodial parents should pay:
income shares method (31 states) - children should receive the same share of their parents' income as if the family lived together;
percentage of income approach (15 states) - children should share in their parents' income but is based on the non-custodial parent's income and the number of children.
Melson-Delaware approach (3 states) - determining what parents need to subsist and determining the amount of support for each child and apportioning between parents.
The federal government helps fund state programs (IV-D) (66%) and states that don't comply are subject to reduced TANF grants.
Some measures used to pressure parents include: revoking drivers' licenses, business, and recreational licenses, posting pictures, publishing names in the media, putting in jail.

Welfare and Work

Focus of AFDC shifted over the years from keeping mothers at home with their children to rehabilitating parents to help them escape poverty.
In 1962 states received a bonus in federal match - $3 for every $1 spent on social services: counseling, vocational training, child management, family-planning, legal services; case loads could not exceed 60.
In 1967 Congress separated payments from social services and emphasized the carrot and stick measures: carrot was the job training program (Work Incentive Now or WIN), stick was the work requirements for unemployed fathers.
Thirty plus one-third rule as instituted - not reducing welfare payments for the first $30 plus the next one-third earned.
Day care was provided.
Short-term training programs generally do not enable recipients to substantially increase their earnings. A combination of a little work and a little welfare help them to survive.

Next in the evolution: Workfare.

Workfare is mandatory employment in return for welfare payments.
Massachusetts Employment and Training Program (ET) was a voluntary program in the 1980s to provide choice between career, education and training and on-the-job training and job placement.
Day care, Medicaid benefits were extended for 12 and 15 months respectively.
Results of workfare programs indicated:
Workfare was successful for AFDC mothers but not fathers
There were savings in welfare costs but recipients didn't do better than welfare alone
Participants without work histories made the greater gains
Participants worked at entry level jobs and did not substantially increase their work skills
Participants and employers were generally pleased but participants were underpaid.

The Job Opportunities and Basic Skills (JOBS) program of 1988.

JOBS (considered a better approach) replaced WIN and offered basic education, job skills and readiness training, community work experience. Day care was provided.
One parent in AFDC was required to work 16 hours per week.
States were required in 1995 to have 20 percent of eligible adults in single-parent families participating in JOBS. National average became 27%.
Both labor force attachment (short term approaches to get people to work quickly, and human capital development approaches (delay work entry in favor of building job skills over time) were utilized.
A three year study showed that single parents in the experimental group earned a total of 22% more than the control group, and received 8% less in AFDC benefits than controls; 53% were still receiving AFDC vs. 56% for controls.

The hot topic of public assistance.

The number of AFDC recipients grew from 1.2m individuals (349K families) in 1940 > 8.5 m individuals (2.2m families) in 1970 > 11.5m individuals (4m families) in 1990.
At the peak in 1994 recipients were 14.2m individuals or 5.5% of the population.
In terms of cost, AFDC benefits totaled $134m in 1940 > $4.9B in 1970 > $19.1B in 1990.
At the peak in 1994, less that 1 (.9)% of all federal, state, and local expenditures went to the program.
Benefits to families have always been modest. In 1970 the average payment per family was $178 and in 1992 $388. Apply the Consumer Price Index (purchasing power) the 1992 figure was a 40% drop in payments; at its peak in 1996, the drop was 51%.
States considered as eligible families whose gross income did not exceed 185%, and net income (following deductions) did not exceed standard need.

Some facts about AFDC

Most families were not as large as people thought (3/4 had 1 or 2 children; 10% had 4 or more).
Most children were young (in 1995 45% under 6 and 82% under 12) which may have prevented a parent from working.
Similar numbers of blacks and whites received AFDC (in 1995 blacks were 37%, whites 36%, Hispanics 21%, Asians 3%, and Native Americans 1%).
Most recipients were not teenagers; in 1995, 80% of mothers receiving AFDC were ages 20-39, 14% were age 40 and older, less than 1/10 were 15-17, and 6% were ages 18-19).
But teen parents are at risk for long term welfare receipt (55% of AFDC mothers were adolescents when they had their first child).
Most AFDC families did not receive public or subsidized housing (23%); most rented private housing (64%).
Most AFDC families received Medicaid and food stamps.
The vast majority of adult recipients have been single mothers (in 1995 only 11% had a father in the home).
68% were not married when their first child was born.
Research indicates that becoming a female head of household with children was by far the most frequent reason that women applied for AFDC--and conversely, changes in family structure (getting married) was most often the way off AFDC, with working for pay the second.
Despite all the attempts at getting AFDC mothers to work, few were working in 1995 (4% worked full time, 5% part time, and only 12% were in training); fathers were a small part of AFDC recipients (5% worked full time, 7% part time, 13% in training; 18% were considered unemployed).
Most families received AFDC for a relatively short time (in 1995 34% had received AFDC for no more than 12 months; 17% for 13 months to 2 years; 28% for 25 months to 5 years; and 20% for more than 5 years).
Regarding the issue of growing up in an AFDC family producing another generation of families on public assistance, the issue isn't clear (one study said 58% another 37%).

Some non-welfare approaches to welfare.

President Nixon proposed his Family Assistance Plan (FAP) - a form of guaranteed annual income.
Another plan has been the negative income tax (NIT); but there is no practical experience with either plan.
Today, the earned income credit (EIT) is available to low-income workers through the IRS.
Individual Development Accounts (IDAs) assist low-income persons with savings.
Some states have established demonstration programs in allowing AFDC families to accumulate assets (Iowa - $2,000, Wyoming - $2,500).
Microeconomic development programs provide start-up funds for unemployed persons to begin businesses.

Welfare reform begins again.

President Reagan's reform of AFDC meant the removal of 500,000 families from the program.
President Bush encouraged more state innovation in the AFDC program.
President Clinton wanted reform but by the time he agreed with Congress on what to do 40 states had already been working on their own plans.

Personal Responsibility and Work Opportunity Reconciliation Act of 1996 ends AFDC.

On the third try Clinton signed the bill into law ending AFDC after 61 years.
Temporary Assistance for Needy Families (TANF) is a block grant program composed of two grants to states:
Family assistance block grant provides cash to families, to help families go to work, and avert out-of-wedlock pregnancies.
Child care grant to help parents with the concern for supervision of their children.
Most families may receive cash assistance for no more than 5 years; families are eligible until their youngest child is 18.
All able-bodied adults who have received public assistance for 2 years are expected to work toward self-sufficiency.
State may exempt 20% of their caseload from the 5 year limit.
The family assistance block grant is capped at $16.4B per year through fiscal year 2002; the child care grant is expanded over the same time period.
To receive its entire TANF allotment, a state must spend at least 75% of what it expended on AFDC in 1994.
After 2 years, or less if the state stipulates, adults must engage in work or be terminated from the program.
Most single parents not participating in job skills or education programs were required to put in 20 hours a week in 1998 and 25 hours in 1999; single parents with children under age 6 are not required to do more than 20 hours a week.
States are required to see that 25% of all TANF families have an adult working in 1997, with an increase of 5% per year until 2002.
There are penalties for failure of states to meet expected goals (5% reduction in TANF funds after the first year and 2% thereafter up to 21%).
Medicaid benefits, due to increased earnings, may be retained by families for 12 months if earnings don't exceed 185% of the poverty level.


To discourage out-of-wedlock births, states may eliminate all cash payments to unmarried teen parents; if states do pay teen parents, they are required live with an adult and attend school.
States can limit TANF payments to the amount provided in a previous state when clients move.
States can also require drug testing and penalize recipients who use illegal drugs.
Welfare to Work Jobs Challenge program provides $3B to encourage communities to create jobs, train, and hire recipients.

Some TANF results
Caseloads have dropped (by 1997, caseloads dropped below 11M for the first time since 1970; by June of 1998, there were 8.4M recipients or 3.1% of the population).
States have been earning money because they get a fixed amount from the federal government based on what was spend in 1994 when caseloads were at an all-time high.
Some states are putting money saved back into the program to provide programs to assist recipients with self-sufficiency
(Wisconsin spends $15,000 per recipient); other states are putting savings into the state's General Revenue fund.
Some states have yet to address obstacles to employment (i.e., drug addiction).
Child care is an issue in that funding is predicted to be inadequate to meet needs.
Many have found work on their own without state support; many have left TANF because they wanted to stay home with their children.
The question remains: Even if families leave the welfare rolls for work, will they escape poverty?


CHAPTER 7
Fighting Hunger: Nutrition Policy and Programs in the United States

Malnutrition is any condition caused by excess or deficient energy or nutrient intake or by an imbalance of nutrients.

Over-nutrition - the term for excess
Under-nutrition - the term for deficiency

Anemias and other nutritional deficiencies cause approximately 3 deaths per 100,000 populations in the U.S.

Low-income continues to be a substantial risk factor in nutrition-related health problems such as anemia, high-serum total cholesterol, hypertension, and being overweight

Policy goal is one of food security
.
Commodity food distribution program

Farmers lobbied to get the USDA and Federal Relief Administration to buy surplus agricultural commodities (1930).
The Federal Surplus Relief Corporation was established to distribute the commodities (1933).
The nation’s first food stamp program was attempted in 1939; persons purchased stamps.
Problems: Program was limited to public assistance recipients; persons had difficulty buying the stamps; criticism that supplies other than food was purchased.
Program ended in 1943.
Food stamps were tried again in 1961; led to passage of the Food Stamp Act of 1964; stamps were worth so much toward food like paper money; purchase requirement eliminated in 1977.

Politics of hunger

In the 1980s (Reagan administration) the food stamp program was tightened up - expenditure cuts and eligibility restrictions enhanced.
New charges emerged that hunger was on the rise; Reagan established a task force to address the issue.
By the mid 1980s, the program was made kinder - AFDC and SSI recipients were automatically eligible; homeless persons were able to participate.

Welfare reform and food stamps

The change from AFDC to TANF also meant tightening of the food stamp program.
The result has been a loss in benefits to recipients: many have been cut out of the program; by 2002 households will be hit by a 20% reduction.
Food stamps are tied to work requirements: if fail to meet work requirements one will only be able to receive stamps for 3 months in a 3-year period.
The PRWORA eliminated many requirements, which standardized the operation of the food stamp program.

Food Stamp Administration

Eligibility is determined through a means test.
Individuals who fall into certain categories also qualify: victims of natural disasters, people living in non-profit facilities (alcoholics living in halfway houses).
In March 1994, the all-time high was around 28m individuals or 11% of the population; by 1998, participants had dropped low below 19m.
In 1996, 60% of households contained children, 20% had a member who was disabled, 7% were age 60 or over.
Despite the changes in 1996, the program remains available to a broader cross-section of the population than any other public assistance program.
About 26% of eligible individuals (31% of eligible households) were not participating in 1994. Reasons for not participating included those of stigma, limited office hours, lengthy forms, and lack of knowledge about the program.

Meals for School Children

Early legislation to help schools serve lunches to students was passed during the Great Depression in 1933.
The National School Lunch Act (1964) established permanent legislation to provide children from low-income families free or low-cost hot lunches.
Family income must not be over 130% of the poverty line to receive free lunches, and between 130% and 185% to receive reduced-price lunches. Meals cost $.40 each.
In 1998-1999 the federal government reimbursed around $1.94 for each free meal, $1.54 for reduced meals, and $.18 for each full-price meal.
Approximately 95,000 schools (public and private) participate; 26 million children; 49% free and 8% reduced.
Approximations in 1997 were $5.2 billion
Criticism of the program centers on whether aid goes to children who need it most - since many poorer schools do not have kitchens - a requirement to participate.
Criticism has also focused on nutritional concerns (i.e. fat, cholesterol, sodium content of food served).
Healthy Meals for Healthy Americans Act of 1994 made it easier for schools to participate in the program and required that school meals meet national dietary standards.
The School Breakfast Program (Child Nutrition Act of 1966) provides breakfasts to children who qualify under free and reduced meals program
Today 69,000 schools or 73% of those with school lunch programs participate; 1998 daily participation was 6.8 million children.
In 1954, the Special Milk Program provided surplus dairy products; today the program is restricted to schools and child-care centers not participating in school lunch or breakfast programs.
Since 1968, the Summer Food Service Program has served children in poor communities during summer vacation.

WIC (Women, Infants, and Children)

Established in 1972; the program is intended to improve the nutrition of low-income women who are pregnant or postpartum, infants, and children to age 5 who are certified as nutritional risks.
Recipients must meet guidelines (i.e., must not have an income higher than 185% of the poverty line, receive other forms of aid - TANF, Medicaid).
WIC is administered by the USDA in conjunction with state health departments.
One study showed a 21% decrease in low-birth-weight infants, a major decrease in neonatal mortality, and a 45% reduction in the number of women with inadequate or no prenatal care.
Appropriations in 1998 were $3.9 million.
In 1992, the Farmers’ Market Nutrition Program added fresh produce to the program in certain communities.

Nutrition for Older Adults

The Older Americans Act of 1965 (amended in 1972) provides funds to states to serve older Americans at congregate sites such as community centers and churches.
Meals-on-Wheels provide meals to home-bound persons that are delivered by volunteers.


CHAPTER 8
Improving Health Care: Treating the Nation's Ills

Is health care a basic human need? Most agree that no one should suffer or die for lack of financial resources to obtain medical attention. But, how much are Americans willing to pay for health care? The political question is how do we decide who gets what care and how?

There is a difference between good health and good medical care.

Health care in the US is supposed to be good, yet, why do we have a lower life expectancy (19th for women and 25th for men) and higher infant mortality (23rd) among 29 industrialized countries?

Black, Hispanic, and poor Americans have greater health problems than do white and more affluent Americans. In 1997 Black infant death rate was 13.8 (2.3 times higher than the white death rate of 6.0).

Medicaid for the Poor

Health care debate for the poor dates back to the turn of the century--progressive era groups proposed and AMA opposed.
Socialized medicine
Fear of government interference in health care

Kerr-Mills Act (1957) began a federal/state matching program for hospital care for the elderly and poor, but not all states participated.

In 1965 changes were made to the Social Security Act to provide health care for the poor and aged. The program established under Title 19 of the act became known as Medicaid. It replaced the older Kerr-Mills program.

All states provide Medicaid. It has grown to be most expensive public assistance program - in 1970 ($5B), 1990 ($72B), and 1998 ($180B).

Medicaid is a joint federal/state program with the federal government paying an average 57% (states receive between 50% and 83% - poorer states receiving more).

States have broad control over Medicaid policy (i.e., they determine reimbursement rates).

Before 1996, all those receiving AFDC were eligible for Medicaid. Since then those receiving TANF don't automatically receive Medicaid. States can terminate benefits to adults who do not meet work requirements and determine length of benefits after they have gone to work.

States must cover pregnant women and children under 6 with incomes 133% of the official poverty level; women are covered for pregnancy services only, but children are entitled to all Medicaid benefits.

States must also cover qualified Medicare beneficiaries (QMBs). These are Medicare beneficiaries who are aged or disabled with incomes below 100% of the federal policy level and resources less than 2X the amount allowed by SSI.

States can cover more groups if they wish.

Many poor do not fit any of the eligibility categories and therefore cannot receive Medicaid (in 1996 about 45% of those poor by government standards received Medicaid.

Medicaid services are provided in kind. Services include inpatient and outpatient hospital care, physicians' services, lab and X-ray, home health care, family-planning, and nurse midwife, among others. States may offer other benefits such as prescription drugs, eyeglasses, psychiatric services under 21 or over 65, developmental disabilities, etc.

In 1997, 33 million people (12% of the US population) were enrolled in Medicaid programs. It is the country's largest purchaser of maternity care and one-fourth of the nation's children are enrolled in the program.

Medicaid pays for 2/3 of nursing home care for elderly or
disabled. 61% of Medicaid funds go to help older and disabled persons who comprise less than 1/3 of Medicaid recipients.

Other adults and children are more than 2/3 of beneficiaries but use less than 1/3 of Medicaid funds.

Medicare for Older Americans

Medicare was established in 1965 at Title 18 of the Social
Security act to help meet the medical needs of the older population.

Medicare is a social insurance program with benefits generally tied to prior contributions; however, it is available to older persons who do not quality for Social Security.

Younger persons can receive benefits providing they have been receiving Social Security Disability Insurance (SSDI) for at least 2 years.

Medicare has two basic programs:

A. Medicare Part A, hospital insurance (HI) pays for hospital
Care, skilled nursing care following hospital stay, some
home health care and hospice care.

HI is compulsory and paid for by a portion of the overall
Social Security payroll tax (1.45%). Older persons who
don't quality for Social Security may buy premiums.

Those using services must pay a deductible ($768 in
1999). Medicare then pays for the remainder of the first
60 days. From 61 to 90 days (1999) the patient's
coinsurance payment is $192 per day.

Medicare Part B, supplemental medical insurance (SMI),
is a voluntary program than covers physician and other outpatient medial services.

In 1999, monthly Part B premiums were $45.50. Premiums are deducted automatically from Social Security checks. Beneficiaries must pay for the first $100 of services themselves each year, after which Medicare pays the remainder 80%.

Persons 65 and older not included in Part A can participate in Part B.

Both Parts A and B require patients to pay an initial charge in order to discourage unnecessary medical care and to recover some program costs.

Medigaps

Medigaps (gaps in public and private insurance programs) include three key areas: 1) prescription drugs, 2) long-term custodial care, and 3) costs of catastrophic illness.

In 1998, Congress passed the Medicare Catastrophic Coverage Act (which placed a surcharge on incomes of Medicare recipients). Later the measure was repealed due to opposition of participants charged the tax.

Many older people have turned to HMOs. They have found these organizations not desiring them due to their use of larger amounts of expensive care compared to younger consumers.

Long-term care is a major medigap. Medicare only covers skilled nursing home care for a short time.

Home health care, the fastest growing Medicare service, provides care for persons in their homes, but not on a 24-hour basis. Most in-home care is provided informally by family, friends, and other non-paid caregivers (which can exact financial and emotional tolls).

In 1996 average annual cost of nursing home care was between $36,000 and $50,000. Nursing home financing can come in three forms:

Patients and/or families pay for care themselves.
For those elderly who are poor Medicaid will pay. Elderly before the Medicaid impoverishment act (1988) had to deplete their assets; today they can keep more of their assets.
Private insurance is increasing being sold to older persons for long-term care (today about 3%). Long-term insurance is purchased to protect assets (i.e., $50,000).
Another type of program involves the elderly purchasing apartments in senior citizens facilities and paying a fixed amount for upkeep and maintenance. At death the property reverts back to the facility.

In 1994 about 1/4 of the elderly (7.3 million) needed at least
some assistance with daily living needs. 3/4 were living in the
community and the rest in nursing homes.

The greatest need is among those 85 and older who are the fastest growing segments of the older population. By 2020, 10 to 14 million may need care and by 2060 the numbers could be 14 to 24 million.

Nearly 3/4 of public long-term care expenditures go to nursing home care. More could be done to promote in-home care (i.e., tax deductions for caregivers).

The National Health Care Bill

Why is the United States first in per capita expenditure, first in percent of GDP (Gross Domestic Product), and has only 46% (last) of population receiving publicly mandated hospital insurance among 14 industrial nations?

Factors that have contributed to the escalation of medical costs:
Third-party financing - private insurance plus Medicaid and Medicare.
Growing number of older persons - those 65 and over use more health care services than the rest of the population.
Advances in medical technology to diagnose and treat disease.
Expansion of medical facilities, including hospital beds; Medicaid funding has led to expansion of new nursing home facilities with more people placed in them.
Threat of malpractice suits results in doctors ordering more tests on patients as a way to protect themselves.
Health care cost inflation.

Holding Down Public Health Care Costs

In the 1983 Congress adopted the diagnosis-related groups (DRGs) system to seek to curb health care costs. The reimbursement method signified what the Medicare would pay for reasonable costs for one of 487 different illnesses.

Hospitals must absorb excess costs for treating a patient and
on the other hand is able to pocket what it saves in treatment.

Gaining control over physician fees was more difficult to achieve. Some physician charges were frozen or caped at a certain level. US Dept. of Health and Human Services determines the fees of participating physicians under the Medicare program.

Participating physicians cannot charge more than the amount
Medicare reimburses.

The Balanced Budget Act of 1997 was an attempt to prevent Medicare exhaustion in 2001, since costs continued to spiral upward.
Lower payments are made to hospitals and doctors; Medicare beneficiaries are charged more (i.e., increase in Part B premiums); and Managed care is emphasized.

Managed Care

Health Maintenance Organizations (HMOs) were developed by private insurance to keep costs down for the private sector.
Doctors are often hired by the organization to serve dues-paying members in clinic settings; some doctors are contracted to see patients in their offices (IPA HMOs - individual practice associations). Fees to doctors are set at a certain level in both arrangements.

PPOs (preferred provider organizations) followed HMOs where employers or insurance carriers reimburse a higher percentage of services if designated facilities (i.e., hospitals) are used.

Some companies self-insure workers and shop around to buy the best plan for the money.

Point of service (POS) plans blend HMO and PPO features. One still has the primary care physician but can see others outside the system if willing to pay more for the service.

HMOs have reined in health care inflation, but not without complaints. Services may be limited to cut costs, discharging persons too early from hospitals, forcing persons to go through primary care physicians, “medlining” (not signing on doctors who treat serious illnesses), locating clinics in affluent area.

Managed care is used also by the public sector but with challenges. A third of Medicaid participants are people with physical or mental disabilities or are older. States have difficulties in attracting HMO providers because of low reimbursement rates and the high service need patients.

Medicare is also being affected by managed care as more elderly enroll in HMOs to reduce out-of-pocket costs.

Provider sponsored organizations (PSOs) are doctors and hospitals going together to offer health care. (HMOs are run by insurance companies; PSOs are run by medical providers).

Health Care for All

In 1997, 70% of Americans has private health insurance for part of the year; 13% had Medicare; 11% had Medicaid; and 3% had military insurance.

The uninsured in 1997 included more than 43 million individuals (16% of the population). Those 18-24 had the least coverage (30%) and those 65 and over the most coverage (99%).

Clinton’s Health Security Act (1993) (which combined government intervention and free-market enterprise) to insure all Americans was rejected.

Incrementalism became the alternative way of providing for those uninsured.
States began to adopt their own plans (Tennessee, Florida)
COBRA - employers could keep their insurance when leaving a job if paid for it themselves
Medical Savings Accounts (MSAs) - medical IRAs - for large medical bills
Childrens Health Insurance Program (CHIP) (Title 21 of the Social Security Act) extends medical coverage to low-income children)


CHAPTER 9
Changing Paradigms in the Poverty Wars: Victories, Defeats, and Stalemates

Curative Strategy in the 1960s War on Poverty

Curative strategy - to help the poor become self-supporting by bringing about changes in these individuals and their environments.
This is in contrast to preventive (social insurance that compels people to save money to relieve economic problems from old age, disability, etc.) and alleviate (public assistance that attempts to ease the hardships of poverty).
Case poverty is viewed as a product of some personal characteristic of the poor - old age, illiteracy, lack of education, low job skills, poor health, race, etc.
Area poverty is seen as the product of economic deficiency relating to a particular sector of the nation, such as West Virginia, Appalachia - where there are pockets of poverty or depressed areas.
To combine the concepts of curative strategy and area poverty the Area Redevelopment Act of 1961 (later Public Works and Economic Development Act or EDA or 1965) was established - federal grants and loans to governments and business for depressed areas.
Community Development Block Grant or CDBG(1974) provides funds to local Community Development Corporations to aid depressed areas with economic development and neighborhood revitalization activities.
Both programs have weathered attacks to survive today - EDA under the Dept. of Commerce, and CDBG under HUD.
To fight case poverty the Manpower Development and Training Act (MDTA) of 1962 - was the first large-scale, federally funded job training program. This program later became the Comprehensive Employment and Training Act of 1973 and later the Job Training Partnership Act of 1982.

Community Action

Economic Opportunity Act was grassroots community action programs to be carried out at the local level by public or private nonprofit agencies, with federal financial assistance.
Project included literacy training, health services, legal aid, neighborhood service centers, child development centers, etc.
Maximum feasible participation was required of residents in program development.

Youth Education

Operation Head Start provided 6 to 8 weeks of summer preparation for low-income children prior to entering kindergarten or first grade.
Job Corps provided education, vocational training, and work experience in centers for hard core unemployable youth between the ages of 16 and 22 (today 14 to 24).
Neighborhood Youth Corps provided work, counseling, and on-the-job training for youth in or out of school who were living at home.

Legal Services

A legal service began with the Economic Opportunity Act, later was established as an independent corporation Legal Services Corporation (LSC) of 1974, and in 1977 became the Legal Services Act.
Legal services have been controversial due to attorneys utilizing federal funds to sue government agencies, conducting lobbying, and other political activities. About 300 centers remain today with another 200 closed.

Great Society Programs established by the Economic Opportunity Act include:

Elementary and Secondary Education Act of 1965 (the 1st major federal aid-to-education program) included funds for poverty-impacted school districts. It remains as the largest source of federal aid to education today.
Food Stamp Program
Medicaid
Medicare
Job Training
The Public Works and Economic Development Act of 1965; and Appalachia Regional Development Act of 1965.

The Politics of War on Poverty

1) There was considerable criticism regarding the direction of the various community action agencies. 2) Many CAA programs duplicated or competed with existing social service programs. 3) Some organized the poor to challenge local governmental agencies. 4) There were complaints of mismanagement and corruption. 5) The lack of knowledge of how to cure poverty was a major flaw. 6) There was the lack of funding to make substantial impact on poverty.
Since the Johnson administrations War on Poverty programs, succeeding presidents and congress worked to reform, dismantle, and expand programs developed.

Head Start

Head Start is one program to survive early War on Poverty programs.
Program evaluation by Westinghouse (survey of 104 Head Start projects across the country with 70% summer and 30% full-year) in 1968 revealed marginal gains in education yet strongly supported by parents.
Carnegie Foundation in 1980 examined 123 low-IQ children (experimental group of 58 provided special Head Start education) and the rest placed into the control group. The Perry Preschool project showed little change in school readiness between the two groups; however, in this longitudinal study the experimental group showed better attitude toward school, likely to finish school and find jobs, and less likely to be involved in crime.
Head Start today enjoys increased funding.

Employment programs

Nixons Comprehensive Employment and Training Act (CETA) (1973) was originally designed to assist the long-term hard core unemployed, but later became a program to help the cyclical unemployed and was used by cities to hire people from the program and save city funds.
Reagan replaced CETA with the Job Training Partnership Act (JTPA) of 1982. The program was a block grant to states to help low-income persons. JTPA exceed program goals but creaming continued.

U.S. Employment Service

The USES was established in 1933 to help millions of depression era unemployed find jobs.
The USES serves both employers and unemployed workers.

Minimum Wage

The Fair Labor Standards Act of 1938 was established to guarantee a wage that would sustain a decent standard of living for all workers.
Concern remains over the minimum wage: if the rate increases employees benefit; however, employers are discouraged from hiring those with limited skills (particularly youth) in order to cut costs.
A sub-minimum or training wage was considered at one time to allow employers to pay teens less during their first few months of employment.
What about welfare reform and the minimum wage?

Enterprise and Empowerment Zones

These programs have the purpose to encourage businesses to locate in economically depressed areas in order to boost employment and the local economy and increase community services.
They provided tax incentives that have created some problems with the loss of federal tax revenues.

Community Service

AmeriCorps provides Americans 18 years and older the opportunity to earn money for college and earn a living stipend in exchange for a year of full-time service. In Tulsa they serve as staff for the TulsaReads program in public schools.
AmeriCorps replaced the VISTA program.


CHAPTER 10
Providing Social Services: Help for Children, the Elderly, and People with Mental Illness

Social Services
1. Who provides social services (5 types of organizations)?

Public agencies (governmental)
Private not-for-profit corporations (voluntary)
Private for-profit corporations (proprietary)
Self-help groups (AA)
Religious organizations (faith-based)

2. Following the rapid increase in spending ($282 million in 1967 to $1.7 billion in 1973) the Reagan administration convinced congress to implement the Social Services Block Grant program (primarily for low-income clients, child welfare, and other services like adult protection).

3. Social services are used to help persons with ADM (alcohol, drug abuse, mental health problems.

48% of those ages 15 to 54 have had a least one psychiatric disorder during their lifetimes, and almost 30 % reported at least one disorder in the last year.
27% of Americans had a substance abuse or dependence diagnosis in their lifetimes.
4.8 million young people ages 12-20 reported that they had engaged in binge drinking (5 or more on at least one occasion in the last month).
4 of every 10 with a lifetime history of at least one disorder ever obtained professional help.

4. Achieving treatment parity (getting insurance to pay for mental illnesses as they do for physical illnesses)

Mental Health Parity Act of 1996 (employers with 50 + employees who offer health plans no imposing more restrictive annual or lifetime dollar limits on these services than they do on medical or surgical care).

5. Finding better treatment for mental disorders.

Psychotherapeutic drugs (1950s) helped lay the groundwork for moving people out of institutions for the mentally ill.
Community Mental Health Centers Construction Act of (1963) mandated that CMHCs provide 5 essential services: inpatient care, outpatient care, emergency services, partial hospitalization (day care), consultation, and education.
Today CMHCs (though they do not have to provide the 5 essential services) must follow State Comprehensive Service Plans related to helping people with serious mental illness, homeless, mental retardation, children with severe disturbances.

6.War on drugs

In 1970 the federal government established the Comprehensive Alcohol Abuse Prevention, Treatment, and Rehabilitation Act that established the NIAAA (alcoholism) followed by NIDA (drugs).
Reagan reduced the amount of funding and placed these programs into a single block grant.
His theme was to declare war on drugs. Focus was placed on supply side and demand side of the drug problem.

7. Mental health rights

Today, consumers in mental health hospitals and drug treatment facilities must be informed of their rights both to obtain and refuse treatment.
Treatment in the least restrictive manner means that it is not appropriate to confine someone in a hospital when a community facility can meet individual needs.
Deinstitutionalization is the focus of today. However, problems hindering this have resulted from restrictive zoning laws creating social service ghettos, and trans-institutionalization - moving patients to other types of facilities such as nursing homes.

Child Welfare Policy

1.Discovering child abuse.

In early America children were considered as chattels - possessions of their parents. Only in some cases were parents prosecuted for extreme abuse.
1874, Mary Ellen, used animal protection laws (children were members of the animal kingdom) to press for reform.
Pediatric radiologists (John Caffey) helped place focus on the battered-child syndrome where many other professionals were not able to do so.
Child maltreatment can mean either abuse or neglect.
Foster care was established in the 1960s to provide out-of-home care for children.
Permanency planning was the catchword of the 1980s through the Adoption Assistance and Child Welfare Act of 1980. The program was a reaction to the many kids lost in the child welfare system.
The Adoption and Safe Families Act of 1997 also placed focus on moving children through the system into permanent placements. Termination procedures can be placed on parents who make no progress to get them back in 15 months. Resources have been placed into adoption programs to move these children into permanent homes.
Fost-adopt is widely used today getting foster families to adopt children.
Independent living programs help children about to age out of the system.
Kinship care is a major focus today in getting children into familiar settings (relatives, friends, neighborhoods).

2.Problems in the system

Social workers often take the blame for what happens or does not happen to children (leave them in the home or removing them).
The state system can get backlogged in cases needing to be investigated.
Stress can be a problem especially for non-social workers who are child welfare workers.
Children are always the double victims (of abuse and of the trauma of removal from abusive homes).
CASA programs help protect the interests of children.
Kinship foster care helps.

Services for Older Americans

The Older Americans Act (OAA) of 1965 created networks to assist the elderly. Area Agencies on Aging (AAAs) work in areas to provided services to the elderly - I&R, transportation, legal counsel, senior centers, visitation and telephone programs, home repair, escort services, home health, home repair, etc.
Guardianship or conservatorship programs empower others to make decisions for the elderly.

CHAPTER 11
Challenging Social Welfare: Racism and Sexism


CHAPTER 12
Implementing and Evaluating Social Welfare Policy: What Happens After a Law is Passed





More to come

Contact Lanny Endicott at lendicott@oru.edu