Article Details

Research Database: Article Details

Citation:  Kneipp, S.M., Kairalla, J.A., & Sheely, A.L. (2013). A randomized controlled trial to improve health among women receiving welfare in the U.S.: The relationship between employment outcomes and the economic recession. , 80 130-140.
Title:  A randomized controlled trial to improve health among women receiving welfare in the U.S.: The relationship between employment outcomes and the economic recession
Authors:  Kneipp, S.M., Kairalla, J.A., & Sheely, A.L.
Year:  2013
Journal/Publication: 
Publisher: 
DOI:  https://doi.org/10.1016/j.socscimed.2012.08.011
Full text:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577993/   
Peer-reviewed?  Yes
NIDILRR-funded?  No

Structured abstract:

Background:  The high prevalence of health conditions among U.S. women receiving Temporary Assistance for Needy Families (TANF, or `welfare') impedes the ability of many in this group to move from `welfare-to-work', and economic factors impact this as well. The jobs women receiving TANF are able to acquire are often short-lived. Regardless of health or other barriers to work, 19–22% of women return to TANF within one year, and 25–30% return within two years (Fagnoni, 2002; Loprest, 1999b; Loprest & Acs, 1996). The primary finding from the RCT is that employment-entry outcomes (any employment and time-to-employment), but not outcomes related to the amount or duration of employment (employment rate and maximum continuous employment ), are improved for women in Welfare Transition Programs (WTPs) with chronic health conditions who receive a public health nursing (PHN) case management intervention to address their health needs when compared to women receiving standard WTP services. Types of jobs; the social/interpersonal, administrative, or quality-related characteristics of jobs; or other competing personal/family demands may further explain the relatively short-lived job tenure observed in this group, regardless of labor market strength and stability (Acs & Loprest, 2007). Providing intensive case management services for TANF participants with substance use barriers improves abstinence rates and employment outcomes.
Study sample:  The RCT included a convenience sample of 432 women enrolled in a WTP in one urban and one rural county in North Central Florida. Study recruitment, enrollment, and follow-up on all participants were completed between February 2007 and April 2010. While the two study counties reflect differences commonly observed between rural and urban settings, unemployment rates differed in the two counties by only .8% prior to the recession onset, and by 1.3% after the recession onset (U. S. Department of Labor, 2011).
Data collection and analysis:  Analyses were conducted using Stata/SE 11.0 and SAS V. 9.2. Employment variables were calculated for participants who completed one or more follow-up measurements at 3, 6, or 9 months; thus our final analytic sample for the employment-related outcomes includes 353 women. Among those who completed each follow-up, less than 11% of data were missing on outcomes of interest; these subjects were deleted case-wise from analyses.
Findings:  Our primary finding from the RCT is that employment-entry outcomes (any employment and time-to-employment), but not outcomes related to the amount or duration of employment (employment rate and maximum continuous employment), are improved for women in Welfare Transition Programs (WTPs) with chronic health conditions who receive a public health nursing (PHN) case management intervention to address their health needs when compared to women receiving standard WTP services. Theoretically, employment entry gains in the intervention group were facilitated by PHNs working to better manage chronic health conditions and decrease health-related functional limitations. As reported elsewhere ( Kneipp et al., 2011), the intervention group did have a significantly greater reduction in depressive symptoms and improvement in functional status than the control group over the 9-month intervention period, suggesting that addressing health barriers in this population can facilitate employment.

Disabilities served:  Multiple disabilities
Populations served:  Consumers receiving federal financial assistance through TANF
Outcomes:  Employment acquisition