Aligning Medicaid &TANF for a two-generation impact on - - PowerPoint PPT Presentation

▶
aligning medicaid tanf for a two generation impact on
SMART_READER_LITE
LIVE PREVIEW

Aligning Medicaid &TANF for a two-generation impact on - - PowerPoint PPT Presentation

Oct 13, 2023 281 likes •549 views

Aligning Medicaid &TANF for a two-generation impact on behavioral health and economic security Academy Health Annual Research Meeting New Orleans June 26, 2017 Mariana Chilton, PhD, MPH Research and Program Teams PI: Mariana Chilton,

slide-1
SLIDE 1

Mariana Chilton, PhD, MPH

Aligning Medicaid &TANF for a two-generation impact on behavioral health and economic security

Academy Health Annual Research Meeting New Orleans June 26, 2017

slide-2
SLIDE 2

Research and Program Teams

PI: Mariana Chilton, PhD, MPH

Professor, Dornsife School of Public Health Director, Center for Hunger-Free Communities

Co- PI: Sandra Bloom, MD

Associate Prof, Dornsife School of Public Health Founder, Sanctuary Institute

Co-I: Jerome Dugan, PhD

Assistant Prof, Drexel College of Nursing H.E.A.L.

Co-I: Layla Booshehri, PhD

Assistant Prof, Drexel College of Nursing H.E.A.L.

Falguni Patel, MPH

Program Manager Building Wealth and Health Network

Kevin Thomas

SELF Empowerment Coach Building Wealth and Health Network

Alie Huxta, MSW

SELF Empowerment Coach Building Wealth and Health Network

Michael Moody

Program Coordinator Building Wealth and Health Network

slide-3
SLIDE 3

Overview

  • Background

– Systems for Action (TANF & Medicaid) – TANF & challenges to economic success – Trauma & trauma-informed practice

  • The Building Wealth and Health Network

– Description of the program – Study design – Preliminary outcomes

slide-4
SLIDE 4

Systems for Action (S4A)

  • 1. Assess effects of trauma-informed peer support built

into education and training on health and economic security for participants in The Network.

  • 2. Identify cost savings to TANF and Medicaid & make a

case for linking these systems.

  • 3. Engage multiple stakeholders to promote a Culture of

Health within anti-poverty programming through a strategic public dissemination effort.

slide-5
SLIDE 5

Background: #TANFat20

  • TANF reaches about 30% of those eligible; this varies by state

(from < 10% to > 40%) 1

– PA -> 31% eligible participating and this is declining

  • Work participation for caregivers w. children < 6yrs = 20hrs;

varying/disappointing success 2

– Return to TANF / Churning

  • Barriers to Work among TANF participants

– 33% report work-limiting health condition3 – 43% report disability 4 – 74% Intimate Partner Violence (Compared to 31% general pop) 5 – High involvement w. criminal justice system6

1. Pavetti, 2015: TANF continues to weaken as a safety net 2. Ctr Study of Social Policy, 2016: 20 Years of TANF 3. Kneipp et al 2011: Public Health Nursing Case Management 4. Loprest & Maag 2009: Disabilities among TANF recipients 5. Cheng 2013: IPV & Welfare Participation 6. Bloom et al, 2011: TANF recipients w. barriers to employment

slide-6
SLIDE 6
  • Toxic Stress (Kids)
  • Overwhelming relentless stress for

young children without adequate support to overcome it

  • Homelessness / poverty
  • Adverse Childhood Experiences (abuse,

neglect, household dysfunction)

  • Impact on development
  • Traumatic Stress (adults)

– Internal and external factors insufficient to cope with external threat – Central nervous system overwhelmed – Helplessness

Background:

What Do We Really Mean By Trauma?

slide-7
SLIDE 7

Category Subcategory Example Question

Abuse Emotional

Emotional Abuse

(Did a parent or other adult in the household...) Often or very often swear at you, insult you, put you down, or humiliate you? OR act in a way that made you afraid you might be physically hurt? Physical Sexual Neglect Emotional Physical Household Instability Parental Separation Mother Abused Mental Illness Substance Abuse Incarceration ADVERSE CHILDHOD EXPERIENENCES

ADVERSE CHILDHOOD EXPERIENCES (ACEs) 10 questions

slide-8
SLIDE 8

ACEs

Strong, graded relation to childhood adversity

Smoking Attempted suicide COPD Revictimization Heart Disease Teen pregnancy Diabetes Fractures Obesity Promiscuity; STDs Hepatitis

Poor self-rated health

Alcoholism Violent relationships Other substance abuse

Low educational attainment Depression Poor job performance

Two Generation Approach

Trauma- informed

slide-9
SLIDE 9

Background:

Trauma -> What’s visible | What’s underneath

Adverse Childhood Experiences Family & Social Dysfunction Trauma & Loss Chronic Hyperarousal & Chronic Inflammation

Historical trauma & social structures based on violence, racism, colonialism, sexism

Behavioral Problems Emotional Dysregulation Physical Illness Financial instability & poor educational outcomes

slide-10
SLIDE 10

What is Trauma-Informed practice?

  • Realizes

– Widespread impact on trauma; paths to recovery

  • Recognizes

– Signs & Symptoms trauma in clients, families, staff, and systems

  • Responds

– Fully integrate knowledge about trauma into policies, procedures and practice

  • Resist

– Actively resists “re-traumatization”

For more info, go here 

slide-11
SLIDE 11

Theory-based, trauma- informed, evidence-supported, whole culture approach for creating / changing an

  • rganizational culture.
slide-12
SLIDE 12
slide-13
SLIDE 13

Network Member Advisory Board

Ongoing Evaluation

The

Building Wealth and Health

Network

Financial Coaching Social Work Referral

Major Components of Building Wealth and Health Network

Matched Savings Accounts

(up to $20 per month provided)

12 months Group Classes & Peer Support Financial SELF Empowerment 4 months

slide-14
SLIDE 14

Curriculum (16 weeks)

Building assets and resiliency

  • S.E.L.F.

– Safety – Emotions – Loss – Future

Trauma-informed peer support Financial Education

  • 1. Bank Accounts 101
  • 2. Savings / Reducing Debt
  • 3. Credit Score
  • 4. Tax help
  • 5. Business planning
  • 6. Planning for an education

/ home

  • 7. Negotiating with your boss
  • 8. Setting financial goals
slide-15
SLIDE 15
  • $5 per wk
  • 1:1 match
  • = ~ $500 per yr

Savings Match w/ Credit Union

(Shareholders)

slide-16
SLIDE 16

Member Advisory Council (20 members)

Provides ongoing feedback on program & dissemination

All participants become Network MEMBERS

slide-17
SLIDE 17

Outcomes Measured (ACASI)

Baseline, 3 month intervals to 12 months

1. Income, Education & Program Participation 2. Financial Wellbeing

  • Assets, savings patterns

3. Economic Security

  • Food Insecurity
  • Housing Insecurity
  • Energy Insecurity

4. Maternal & Child Health and Development

  • CES-D (Center for Epidemiologic Studies - Depression)
  • Self-Rated Health
  • PEDS (Parents’ Evaluation of Developmental Status Survey)
  • Caregiver rated Health

See Sun et al (2016) BMC Public Health

slide-18
SLIDE 18

Network ACASI Survey Completion Cohort Baseline 3-month 6-month 9-month 12-month Cohort 1 (Non-TANF) 31 27 (87%) 24 (77%) 23 (74%) 24 (77%) Cohort 2 (TANF) 67 47 (70%) 33 (49%) 40 (59%) 33 (49%) Cohort 3 (Non-TANF) 28 23 (82%) 18 (64%) 18 (64%) 18 (64%) Cohort 4 (TANF) 37 26 (70%) 21 (57%) 17 (46%) Cohort 5 (TANF) 36 22 (56%) 28 (76%) 17 (46%)* Cohort 6 (Non-TANF) 25 20 (80%) 17 (68%) 8 (32%)* Cohort 7 (TANF) 33 19 (58%) Cohort 8 (TANF) 26 16 (62%) Cohort 9 (Non-TANF) 32 17 (53%) TOTAL 316 217 141 123 75

*indicates follow-up is ongoing; total % changes every day as people cycle in for appointments

Ongoing Recruitment & Survey Participation

slide-19
SLIDE 19

47% 62% 46% 18% 28% 71% 71% 53% 42% 67% 70% 73% 67% 49% 62%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Household Food Secure* Caregiver Health Excellent/Good+ No Depressive Symptoms+ Employed* Savings Account*

Selected Results of Ongoing Evaluation – The Network October 2015-April 2017

Baseline (N=126) 6-Month (N=76) 12-Month (N=74)

* p < .05 ; + p < .10

slide-20
SLIDE 20

Phase II Preliminary (Oct ‘15-Feb ‘17) Household Food Security

47% 73% 62% 68% 33% 64% 57% 62% 0% 10% 20% 30% 40% 50% 60% 70% 80% Baseline (N=94) 6-month (N=48) 9-month (N=60) 12-Month (N=53) Percent of Participants Food Secure* Food Secure (4+ ACEs)*

N=24 N=14 N=13 N=11

*Statistically significant, p<0.05

N=24 N=14 N=13 N=11

slide-21
SLIDE 21

65% 77% 75% 81% 58% 55% 50% 77% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Baseline (N=94) 6-month (N=48) 9-month (N=60) 12-Month (N=53) Percent of Participants

Caregiver Health (p=0.02) Caregiver Health (4+ ACEs)

N=24 N=14 N=13 N=11

Phase II: Preliminary (Oct ‘15-Feb ‘17) Caregiver Health

N=24 N=14 N=13 N=11

slide-22
SLIDE 22

54% 50% 55% 40% 79% 46% 71% 46% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Baseline (N=94) 6-month (N=48) 9-month (N=60) 12-Month (N=53) Percent of Participants

Depression Depression (4+ ACEs) p=0.04

N=24 N=14 N=13 N=11

Phase II: Preliminary (Oct ‘15-Feb ‘17) Depressive Symptoms

N=24 N=14 N=13 N=11

slide-23
SLIDE 23

18% 44% 42% 55% 21% 55% 36% 54% 0% 10% 20% 30% 40% 50% 60% Baseline (N=94) 6-month (N=48) 9-month (N=60) 12-Month (N=53) Percent of Participants

Currently Employed (p<0.0001) Currently Employed (4+ ACEs) (p=0.03)

N=24 N=14 N=13 N=11

Phase II: Preliminary (Oct ‘15-Feb ‘17) Employment

N=24 N=14 N=13 N=11

slide-24
SLIDE 24

40% 63% 65% 70% 50% 55% 64% 77% 28% 71% 63% 70% 29% 82% 79% 92% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Baseline (N=94) 6-month (N=48) 9-month (N=60) 12-Month (N=53) Percent of Participants

Checking Account* Checking Account (4+ ACEs)* Savings Account* Savings Account (4+ ACEs)*

N=24 N=14 N=13 N=11

*Statistically significant, p<0.05

Phase II: Preliminary (Oct ‘15-Feb ‘17) Banking

N=24 N=14 N=13 N=11

slide-25
SLIDE 25

Network Member #4 Network Member #3 Network Member #1 Network Member #2

slide-26
SLIDE 26

Mariana Chilton, PhD, MPH

mmc33@drexexl.edu 267-359-6026 @thebwhnetwork