Addressing Behavioral Health in TANF to Improve Health Equity Among Low-Income Caregivers (Dissemination and Implementation Conference 2017)


Background: Caregivers of young children in Temporary Assistance for Needy Families (TANF) are required to complete 20hrs/week of work participation, and are hurried into employment, often without consideration for their health and their children’s wellbeing. For instance, TANF caregivers report high rates of work limiting health conditions, as well as Adverse Childhood Experiences (ACEs) which can transfer to their children through severe hardship, depression, and trauma-related behavior. Additionally, the racial and ethnic wealth gap among women in the United States continues to persist, where women of color have few to no assets, and little to no savings to help their families weather economic shocks, which in turn puts their health at greater risk.

Methods: This implementation study builds on the Building Wealth and Health Network (The Network) randomized controlled trial (RCT) that substituted standard TANF programming with trauma-informed peer support, financial education, and matched-savings accounts. The RCT showed significant reductions in depressive symptoms and hardship related to food, housing and utilities. In the Phase II implementation of The Network we revised the curriculum to be implemented over a shorter timeframe, which includes 16-weeks of trauma-informed financial empowerment and 12 months of matched-savings. We are carrying out rapid-cycle evaluation at baseline, and every three months over 12 months with Audio Computer-Assisted Self-Interview (ACASI) software to track economic hardship, behavioral health, and labor market outcomes.

Findings: At baseline, among the 225 members recruited thus far, 32.6% of participants have some college, 16.4% are employed, 52% are food insecure, and 25.5% report ≥4 ACES. Rapid-cycle evaluation results with 97 participants that completed Phase II reveal improvements in food security (47.4% to 67.9% at 12mo, p=0.006); and reductions in depressive symptoms for caregivers reporting ≥4 ACEs (79.2% to 46.2% at 12mo, p=0.04) and a significant increase in employment (18.1% to 54.7% at 12mo, p <0.0001). We are also examining associated cost savings to Medicaid behavioral health and TANF program expenditures.

Implications for D&I Research: Policy implications from our results identify the importance of linking Medicaid with TANF to promote a culture of health within TANF, and to improve health equity.


Presentations (Oral or Poster)
Patel F, Chilton M, Dugan J, Bloom S, Booshehri L

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