Supports for the City's Most Vulnerable Residents
The most vulnerable residents of cities often struggle to access the different benefits and sources and nonprofit organizations provide. It is a perennial challenge of social work and related fields to more seamlessly connect the different "silos" of the soical safety net—a complex web of government programs designed to stabilize our most vulnerable and help them to thrive—so that individuals and families can spend more time capitalizing on those resources, and less time hunting to find them.
The inter-related nature of many of these individual programs—including income support, medical insurance, child care assistance, and protection of children at risk for abuse and neglect—is a key theme at SSA. The following profiles highlight some of the work our faculty members have done to help policymakers grapple with these complexities, and make the safety net more effective for those whose well-being depends upon it.
How Shifts in Income Support Policy Impact Vulnerable Families
Despite high levels of labor market participation in U.S. cities, many workers and their families remain below the poverty line. Other city residents are unable to work at all, due to health issues, child care or elder care responsibilities, and other barriers to participating in the labor market. Assistant Professor Marci A. Ybarra’s research examines the implications of safety net policy changes for the well-being of low-income families. Cities’ most vulnerable residents are susceptible to becoming or remaining poor for different reasons, and our safety net offers different kinds of assistance to try to meet distinct needs. Ybarra’s work provides important insights about how and for whom our safety net works best, and why, and for whom it falters.
For example, much research has shown that the welfare reforms of the 1990s provided the greatest benefits to the working poor, allowing them to increase their work hours and thereby their incomes. One of Ybarra’s studies, however, shows that these same reforms contributed to increased hardship and deepening poverty for those families least able to participate in the labor market. In essence, welfare reform has left these most vulnerable families farther behind, and our safety net has not found a way to meet their needs. In another study, Ybarra has found that the variation in safety net generosity across states—for example, some states require more hours of work to access benefits, while offering less access to child care—means residents of some states have a better chance at establishing stable employment and reliable child care than do residents of other states. This variability in what the safety net provides means that residents of some states sink deeper into poverty despite articulated national policy goals of both rewarding employment and supporting families.
Most recently, Ybarra has compared the benefits that expectant and new mothers can access through traditional, means-tested welfare programs—TANF, WIC, and Medicaid—to two social insurance programs that some states offer to all regardless of income—paid family leave and temporary disability payments. She finds that the traditional welfare programs do a much better job of supporting poor, single mothers after they give birth. Ybarra’s work directs policymakers’ attention to a high-stakes question: will our safety net continue to move away from means-tested supports and towards work-based and insurance forms of assistance, even as that shift increases the misery of our most vulnerable children and families?
Shaping Medicaid to Meet the Complex Needs of the Most Vulnerable
Harold Pollack, SSA's Helen Ross Professor, has devoted his research to learning how to better support vulnerable individuals whose challenges lie at the intersection of behavioral health and criminal justice systems. His work has been part of a larger movement to reconceptualize these seemingly distinct human service areas as a collection of factors underlying individuals’ general well-being and health. Working from this point of view, much of his work has tried to understand how government programs and regulations, such as Medicaid and the tools provided by the Affordable Care Act, could better address these complex needs.
In one line of research, Pollack has examined different approaches to addiction treatment, which is a rising challenge in cities and rural areas alike. Today’s opioid crisis has drawn attention to the fact that Medicaid is a key provider of addiction treatment, and work by Pollack and others, including SSA Professor Colleen Grogan, is now exploring how different states use tools provided by the Affordable Care Act to expand services to treat addiction.
Pollack’s newest work focuses on building new safety net approaches for those with behavioral health disorders, and thinking about how to realign Medicaid policy to support successful new ideas. Much research has shown that behavioral health challenges contribute to chronic homelessness as well as involvement with the criminal justice system. Protecting vulnerable individuals from these critical threats to their well-being requires attending to the intersection of these multiple stressors. Pollack is working with a team at the University of Chicago Health Lab and several nonprofit partner agencies to implement and evaluate new strategies from this perspective. One, the Supportive Release Center, seeks to prevent homelessness and reoffending among Cook County Jail detainees with behavioral health disorders by providing intensive support and monitoring to newly released individuals. A second addresses protocols for police emergency services personnel who encounter individuals in behavioral crisis. Pollack and his team are working closely with city government agencies and nonprofit partners to combine rigorous program evaluation with due attention to the realities of fielding effective interventions. Pollack hopes to use results from these interventions and evaluations to encourage better alignment of Medicaid coverage rules with demonstrated effectiveness in programs.
Too old for the child welfare system but often not yet prepared to live as independent young adults, the approximately 29,500 foster youth who “age out” of care each year (US-DHHS, 2009) are expected to make it on their own long before the vast majority of their peers.
Children at Risk of Abuse and Neglect Need Development, Not Just Protection
When Professor Mark Courtney started researching the child welfare system more than twenty years ago, its emphasis was on protecting children from potentially dangerous situations. Courtney’s work has been instrumental in shifting child welfare services towards greater concern with the healthy development of at-risk children, instead of a more narrowly conceived protective orientation.
Courtney’s insights grew out of his groundbreaking studies on children who “aged out” of foster care. Most children in foster care exit the system by returning to their families or being adopted. But more than 24,000 kids a year who are in care when they hit their 18th birthday are emancipated from the system: no longer the responsibility of the state. Courtney suspected that 18-year-olds were not ready to be on their own, especially after going through the trauma and challenges of being separated from their families of origin. His early research demonstrated that this was in fact the case: by the age of 20, large percentages of aged-out foster youth were facing homelessness, unemployment, and incarceration. These findings, and Courtney’s promotion of them to federal and state policymakers, contributed to changes in federal law that ultimately led to increasing numbers of states changing their policies to allow youth to remain in foster care until age 21. Today, providers of these extra years in care are focused on developing young people’s emotional resilience, employment readiness, and supportive relationships in anticipation of independent living.
The developmentally-oriented lessons of Courtney’s original work on aging-out foster youth has led him to his current research on the needs of teenagers in foster care. Most child welfare services focus on the needs of younger children, and are oriented towards the important goal of family permanency: reunification with the family of origin, or adoption. Teenagers, however, need different kinds of services that will support them through the rocky developmental period of adolescence. And there are differences in needs depending on the teens themselves as well as their environment.
A few examples from Courtney’s research in California indicate that youth besiding in large urban areas (such as Los Angeles) reported that they were less likely to receive services than those in rural or nonmetropolitan areas. However, larger proportions of youth in rural counties had a greater than moderate need for mental health services (53.8 percent) than urban counties (28.4 percent) and large urban counties (37 percent).
Courtney is intent on learning exactly what kinds of supports will best achieve the goal of supporting all foster teenagers through early adulthood to ensure that they can become successful, healthy, and capable adults while lowering the possibility of future public costs of incarceration and homelessness.
Next: Urban (In)Justice: Transforming Criminal Justice in Cities