Laurie M. Jacobs

Substance abuse* and employment among welfare mothers : From welfare to work and back again?

We have very little research on how substance use impacts employment among welfare mothers. But welfare reforms emphasis on moving aid recipients into the workforce has brought this issue to the fore. Using Cox proportional hazard and logistic regression in a longitudinal study of California welfare mothers in 2001–2003, we examine how substance use impacts the ability to move from welfare to work and to remain economically independent after welfare. While education, work history, and family size consistently predict transitions from welfare to work and back again, substance use-related problems consistently do not. However, the jobs obtained by welfare mothers are short-term and poorly paid regardless of whether they misuse alcohol or use drugs. We argue that, if all that is open to welfare mothers are short-lived work assignments, substance use may have little time to impact job retention. Limitations of the study are noted. This IRB-approved study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism.

On the Declining Health Status of Welfare Caseloads: Emerging Dilemmas for Serving the Poor

An emerging concern for public policy is welfare reforms potential to inadvertently affect caseload composition by increasing the proportion of recipients with health-related barriers to employment. The authors examine this using data from the Welfare Client Longitudinal Study, an in-depth case study of a large California county. Through quantitative analyses, they examine the extent of change in health-related problems since welfare reform and their potential to progressively impact overall composition of the caseload. They augment this with qualitative data on how local welfare providers are responding to the health-related needs of aid recipients. Results suggest that the burden of health-related problems is growing and that welfare providers may be poorly equipped to respond effectively on their own. The changing composition of welfare caseloads may foster several new policy dilemmas that demand broader attention: states and localities may face difficulties meeting federal workforce participation requirements, may need to restructure welfare-to-work programs to serve a more functionally impaired population, and may need to take steps to better integrate health and welfare services at the local level.

Measuring Consumer Engagement: A Review of Tools and Findings

ABSTRACT Consumer engagement is increasingly emphasized in healthcare initiatives and has been a priority in healthcare reforms. Consumer engagement takes multiple forms, including increased involvement of consumers in their own care, in organizational design, and in broader policy decision-making processes. Determining the effectiveness of such involvement requires both effective measurement and empirical study, both of which have yet to be standardized or fully explored. In this review, we examine both existing measurement tools for consumer engagement and current empirical knowledge regarding the outcomes associated with each of three levels of consumer engagement. Although measurement and results at the level of direct care are more established, measurement of consumer engagement, let alone its effects at the organizational design or policy level, is less well developed. Building on our review, we make suggestions for how to fill the current gaps in understanding the measurement and outcomes of consumer engagement.