The Building Wealth and Health Network: methods and baseline characteristics from a randomized controlled trial for families with young children participating in temporary assistance for needy families (TANF)

Abstract

BackgroundFamilies with children under age six participating in the Temporary Assistance for Needy Families Program (TANF) must participate in work-related activities for 20 h per week. However, due to financial hardship, poor health, and exposure to violence and adversity, families may experience great difficulty in reaching self-sufficiency. The purpose of this report is to describe study design and baseline findings of a trauma-informed financial empowerment and peer support intervention meant to mitigate these hardships.MethodsWe conducted a randomized controlled trial of a 28-week intervention called Building Wealth and Health Network to improve financial security and maternal and child health among caregivers participating in TANF. Participants, recruited from County Assistance offices in Philadelphia, PA, were randomized into two intervention groups (partial and full) and one control group. Participants completed questionnaires at baseline to assess career readiness, economic hardship, health and wellbeing, exposure to adversity and violence, and interaction with criminal justice systems.ResultsBaseline characteristics demonstrate that among 103 participants, there were no significant differences by group. Mean age of participants was 25 years, and youngest child was 30 months. The majority of participants were women (94.2 %), never married (83.5 %), unemployed (94.2 %), and without a bank account (66.0 %). Many reported economic hardship (32.0 % very low household food secure, 65.0 % housing insecure, and 31.1 % severe energy insecure), and depression (57.3 %). Exposure to adversity was prevalent, where 38.8 % reported four or more Adverse Childhood Experiences including abuse, neglect and household dysfunction. In terms of community violence, 64.7 % saw a seriously wounded person after an incident of violence, and 27.2 % had seen someone killed. Finally, 14.6 % spent time in an adult correctional institution, and 48.5 % of the fathers of the youngest child spent time in prison.ConclusionsBaseline findings demonstrate that caregivers participating in TANF have suffered significant childhood adversity, adult violence exposure, and poverty-related stressors that can limit workforce success. High prevalence of housing and food insecurity, exposure to adversity, violence and criminal justice systems demands comprehensive programming to support families. Trauma-informed approaches to career readiness such as the Building Wealth and Health Network offer opportunities for potential success in the workforce.Trial registrationThis study is retrospectively registered with ClinicalTrials.govThe Identifier is: NCT02577705The Registration date is October 13, 2015

Trauma-informed Temporary Assistance for Needy Families (TANF): A Randomized Controlled Trial with a Two-Generation Impact

“…Recruited by research staff at three county assistance offices, the 103 participants were randomized into three groups: 31 in the control group, 35 in the partial intervention, and 37 in the full intervention (Table 1 ). While basic characteristics have already been reported in a previous publication (Sun et al 2016 ), we highlight across all groups high rates of depressive symptoms ranging from 49 to 62%, and at least one concern of child developmental risk ranging from 12.9 to 22.9%, and over half of the participants reporting moderate to severe food, housing, or utility hardship. Additionally, over 90% of the sample was unemployed at baseline.…”

“… Chi-square and Wilcoxen-Mann Whitney tests analysis showed no between-group differences, except for caregiver age ( p = 0.07). See (Sun et al 2016 ) for more comprehensive review …”

“…Caregivers reported on the health and wellbeing of their children at baseline, and 36% reported their young children to be at risk for cognitive, social, and emotional delay, and almost half (48.5%) of their fathers spent time in prison. A full description of methods and baseline characteristics are outlined in a previous publication (Sun et al 2016 ). The Network RCT ran from June 2014 to December 2015; Clinical trial registration number NCT02577705.…”

Does Employment-Related Resilience Affect the Relationship between Childhood Adversity, Community Violence, and Depression?

“…Basic demographics of participants in our study can be found in a previous publication [42]. Study participants were mainly young (mean, 25.4 years), never married (84.1%), heterosexual (83.5%), women (94.2%), Black/ African-American (91.3%), and non-Hispanic (95.1%).…”

“…Eligibility included TANF benefits receipt for 4 years or less, at least one child under 6, and being deemed Bworkmandatory,^meaning that participants were required to participate in at least 20 h of Bwork participation^per week in order to receive TANF benefits. For more details of the Network RCT design and methods, see our previous publication [42]. Surveys were conducted using Audio Computer-Assisted Self-Interview (ACASI) software from the Nova Research Corporation.…”