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The SSRC Library allows visitors to access materials related to self-sufficiency programs, practice and research. Visitors can view common search terms, conduct a keyword search or create a custom search using any combination of the filters at the left side of this page. To conduct a keyword search, type a term or combination of terms into the search box below, select whether you want to search the exact phrase or the words in any order, and click on the blue button to the right of the search box to view relevant results.

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  • Individual Author: Zogg, Cheryl K.; Scott, John W.; Metcalfe, David; Gluck, Abbe R.; Curfman, Gregory D.; Davis, Kimberly A.; Dimick, Justin B.; Haider, Adil H.
    Reference Type: Journal Article
    Year: 2019

    Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

    Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

    Design, Setting, and Participants Quasi-experimental, difference-in-difference analysis assessed adult trauma in patients aged 19 to 64 years in 5 Medicaid expansion (Colorado,...

    Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

    Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

    Design, Setting, and Participants Quasi-experimental, difference-in-difference analysis assessed adult trauma in patients aged 19 to 64 years in 5 Medicaid expansion (Colorado, Illinois, Minnesota, New Jersey, and New Mexico) and 4 nonexpansion (Florida, Nebraska, North Carolina, and Texas) states.

    Interventions/Exposure Policy implementation in January 2014.

    Main Outcomes and Measures Changes in insurance coverage, outcomes (mortality, morbidity, failure to rescue, and length of stay), and discharge to rehabilitation.

    Results A total of 283 878 patients from Medicaid expansion states and 285 851 patients from nonexpansion states were included (mean age [SD], 41.9 [14.1] years; 206 698 [36.3%] women). Adults with injuries in expansion states experienced a 13.7 percentage point increase in discharge to rehabilitation (95% CI, 7.0-7.8; baseline: 14.7%) that persisted across inpatient rehabilitation facilities (4.5 percentage points), home health agencies (2.9 percentage points), and skilled nursing facilities (1.0 percentage points). There was also a 2.6 percentage point drop in failure to rescue and a 0.84-day increase in length of stay. Rehabilitation changes were most pronounced among patients eligible for rehabilitation coverage under the 2-midnight (8.4 percentage points) and 60% (10.2 percentage points) Medicaid payment rules. Medicaid expansion increased rehabilitation access for patients with the most severe injuries and conditions requiring postdischarge care (eg, pelvic fracture). It mitigated race/ethnicity-, age-, and sex-based disparities in which patients use rehabilitation.

    Conclusions and relevance This multistate assessment demonstrated significant changes in insurance coverage and discharge to rehabilitation among adult trauma patients that were greater in Medicaid expansion than nonexpansion states. By targeting subgroups of the trauma population most likely to be uninsured, rehabilitation gains associated with Medicaid have the potential to improve survival and functional outcomes for more than 60 000 additional adult trauma patients nationally in expansion states. (Author abstract)

  • Individual Author: Hahn, Heather; Rohacek, Monica; Isaacs, Julia
    Reference Type: Report
    Year: 2018

    Child care subsidies are critical for the well-being of low-income families, including parents’ economic success and children’s development. To inform state efforts to simplify access to child care subsidies and improve service delivery, this report highlights steps taken and lessons learned by five states that participated in the Work Support Strategies initiative between 2012 and 2015. These states worked to improve child care subsidy access and retention, efficiency of service delivery, quality of client service, and alignment with other benefit programs. The report also discusses the implications of these findings for implementation of the reauthorized Child Care and Development Fund. (Author abstract)

    Child care subsidies are critical for the well-being of low-income families, including parents’ economic success and children’s development. To inform state efforts to simplify access to child care subsidies and improve service delivery, this report highlights steps taken and lessons learned by five states that participated in the Work Support Strategies initiative between 2012 and 2015. These states worked to improve child care subsidy access and retention, efficiency of service delivery, quality of client service, and alignment with other benefit programs. The report also discusses the implications of these findings for implementation of the reauthorized Child Care and Development Fund. (Author abstract)

  • Individual Author: Kia-Keating, Maryam; Nylund-Gibson, Karen ; Kia-Keating, Brett M. ; Schock, Christine ; Grimm, Ryan P.
    Reference Type: Journal Article
    Year: 2018

    Early poverty is associated with a cumulative load of family and community risk factors that can impact the development of self-regulatory abilities and result in socio-emotional and achievement gaps which begin early and persist across the lifespan. Ethnic minorities are disproportionately represented among children living in poverty. The longitudinal trajectories of self-regulation are important to understand in this population, in order to best inform prevention efforts. This study examines patterns of self-regulation over time among young, ethnic minority children living in low income, urban households. A stratified, random sample of 555 children, ages 2 to 4 years, (46% Black, 46% Hispanic; 47% female) were followed over three waves (including 1 and 5 year follow-ups). Internalizing and externalizing behaviors at approximately age nine were predicted by children’s early self-regulation. Latent class analyses revealed low, medium, and high levels of self-regulatory abilities at wave 1 (mean age: 2.99, SD = .81) and low and high levels, 1 year later (mean age: 4.39 (SD = .94...

    Early poverty is associated with a cumulative load of family and community risk factors that can impact the development of self-regulatory abilities and result in socio-emotional and achievement gaps which begin early and persist across the lifespan. Ethnic minorities are disproportionately represented among children living in poverty. The longitudinal trajectories of self-regulation are important to understand in this population, in order to best inform prevention efforts. This study examines patterns of self-regulation over time among young, ethnic minority children living in low income, urban households. A stratified, random sample of 555 children, ages 2 to 4 years, (46% Black, 46% Hispanic; 47% female) were followed over three waves (including 1 and 5 year follow-ups). Internalizing and externalizing behaviors at approximately age nine were predicted by children’s early self-regulation. Latent class analyses revealed low, medium, and high levels of self-regulatory abilities at wave 1 (mean age: 2.99, SD = .81) and low and high levels, 1 year later (mean age: 4.39 (SD = .94). A gender effect was found whereby girls were more likely than boys to be in the high self-regulation class relative to the low at both waves. Using Latent Transition Analysis, distal outcomes were examined approximately 5 years after the initial assessment (mean age: 8.83, SD = .93). Children who sustained a higher level of self-regulation over time had the lowest internalizing and externalizing behaviors. Transition to low self-regulation at wave 2, regardless of initial self-regulation status, was related to greater severity of internalizing symptoms. Implications for prevention and future research are discussed. (Author abstract)

     

  • Individual Author: Hong, Philip Young P; Choi, Sangmi; Key, Whitney
    Reference Type: Journal Article
    Year: 2018

    The purpose of this study was, first, to validate the factor structure of psychological self-sufficiency (PSS) and, second, to investigate the extent to which PSS affects economic self-sufficiency (ESS) among low-income job seekers. PSS is conceptualized as a transformative process-driven psychological capital that comprises employment hope and perceived employment barriers. Using a sample of 802 low-income job seekers from two different local job training programs in Chicago, a multisample confirmatory factor analysis tested the factor structure of PSS, and a structural equation modeling analysis was conducted to test the hypothesized pathways to ESS, examining employment hope and perceived employment barriers individually and taking the difference score between the two. Findings revealed that PSS significantly contributes to ESS. Workforce development practitioners need to focus on clients’ PSS when working with them to achieve ESS. Benchmarking PSS, providing adequate supportive services, and engaging employers are warranted as ways to build a system that generates successful...

    The purpose of this study was, first, to validate the factor structure of psychological self-sufficiency (PSS) and, second, to investigate the extent to which PSS affects economic self-sufficiency (ESS) among low-income job seekers. PSS is conceptualized as a transformative process-driven psychological capital that comprises employment hope and perceived employment barriers. Using a sample of 802 low-income job seekers from two different local job training programs in Chicago, a multisample confirmatory factor analysis tested the factor structure of PSS, and a structural equation modeling analysis was conducted to test the hypothesized pathways to ESS, examining employment hope and perceived employment barriers individually and taking the difference score between the two. Findings revealed that PSS significantly contributes to ESS. Workforce development practitioners need to focus on clients’ PSS when working with them to achieve ESS. Benchmarking PSS, providing adequate supportive services, and engaging employers are warranted as ways to build a system that generates successful employment and retention paths and outcomes. (Author abstract)

  • Individual Author: Mendenhall, Ruby
    Reference Type: Journal Article
    Year: 2018

    Scholars are beginning to use the concept medicalization of poverty to theorize how the United States spends large amounts of money on illnesses related to poverty but invests much less in preventing these illnesses and the conditions that create them (e.g., economic insecurity, housing instability, continuous exposure to violence, and racism). This study examines the connection between poverty, disease burden and health-related costs through the in-depth interviews of 86 Black mothers living in neighborhoods with high levels of violence on the South Side of Chicago. The rippling costs of poverty and violence include 56 percent of the mothers reporting post-traumatic stress disorder symptoms and 48 percent reporting mild to severe depressive symptoms. Mothers also report poor housing quality such as “toxic mold.” The physical costs include reports of back pains, stomach aches, hair falling out, panic attacks, hands shaking, insomnia (sometimes for two days), fainting from exhaustion and lack of sexual desire, and children with asthma and osteomyelitis reportedly from the exposure...

    Scholars are beginning to use the concept medicalization of poverty to theorize how the United States spends large amounts of money on illnesses related to poverty but invests much less in preventing these illnesses and the conditions that create them (e.g., economic insecurity, housing instability, continuous exposure to violence, and racism). This study examines the connection between poverty, disease burden and health-related costs through the in-depth interviews of 86 Black mothers living in neighborhoods with high levels of violence on the South Side of Chicago. The rippling costs of poverty and violence include 56 percent of the mothers reporting post-traumatic stress disorder symptoms and 48 percent reporting mild to severe depressive symptoms. Mothers also report poor housing quality such as “toxic mold.” The physical costs include reports of back pains, stomach aches, hair falling out, panic attacks, hands shaking, insomnia (sometimes for two days), fainting from exhaustion and lack of sexual desire, and children with asthma and osteomyelitis reportedly from the exposure to mold. Transformative solutions are explored that build upon the cultural resources of Black mothers (e.g., women-centered networks, spirituality and collective-cooperatives) and engage policy levers (e.g., Earned Income Tax Credit and Tax Increment Financing). (Author abstract)

     

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