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Presented at: Protecting Children’s Need for Nurturance: Proven Strategies and New Ideas

Policies Supporting Working Families Having Children with Special Health Care Needs: A Transnational Comparison. Presented at: Protecting Children’s Need for Nurturance: Proven Strategies and New Ideas March 23, 2006 Oregon Child Advocacy Project Eugene, Oregon.

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Presented at: Protecting Children’s Need for Nurturance: Proven Strategies and New Ideas

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  1. Policies Supporting Working Families Having Children with Special Health Care Needs:A Transnational Comparison Presented at: Protecting Children’s Need for Nurturance: Proven Strategies and New Ideas March 23, 2006 Oregon Child Advocacy Project Eugene, Oregon

  2. Today’s presentation is based on a paper written by Eileen M. BrennanGraduate School of Social WorkPortland State University, U.S.A.AndPeter MarshDepartment of Sociological StudiesUniversity of Sheffield, United Kingdom

  3. Portland, Oregon Funds to support this activity come from The Child, Adolescent and Family Branch, Center for Mental Health Services, Substance Abuse Mental Health Services Administration, U.S. Department of Health and Human Services; and from The National Institute on Disability and Rehabilitation Research, U.S. Department of Education.(Grant No. HI33B40038). Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services National Institute on Disability and Rehabilitation Research, U.S. Department of Education

  4. Protecting the Nurturance of Children with Special Health Care Needs • A widening gap exists between demands on parents at home and the 24/7 workplace and the supports that are available in the community (Heymann, 2000). • The gap is particularly pronounced for working parents of children with special needs (Freedman, Litchfield, & Warfield, 1995; Kagan, Lewis, & Heaton, 2001; Kendall, 1998). • 20% of US households have a child with special health care needs (Child and Adolescent Health Initiative, 2003). Protecting Children's Need for Nurturance 2006

  5. Maintaining Employment Difficult While Meeting Children’s Needs • 13.5% of parents of children with special health care needs spend 11 or more hours a week coordinating health care (CAHI, 2004). • Nearly one in three family members cut back work or stopped working due to their children’s health care needs (CAHI, 2004; Powers, 2003). • More particularly, parents of children with emotional or behavioral disorders face “courtesy stigma” in the workplace, and often quit work or are dismissed due to the unpredictable demands of caring for their children and the few outside resources in the community (Rosenzweig & Huffstutter, 2004; Bradley, Huffstutter, Brennan, & Rosenzweig, 2005). Protecting Children's Need for Nurturance 2006

  6. The Morrison Family • Susan—a young child with difficult behavior has been expelled from child care repeatedly, needs treatment for her mental health problems, and faces an uncertain future in the public school system. • Jeanne—her single mother has had difficulty maintaining employment given Susan’s care needs, and her responsibilities to Susan’s older sister, and is worried about losing her job and her insurance altogether. • Support sources— the family is supported by Jeanne’s mother and neighbor, but this support is wearing thin. Protecting Children's Need for Nurturance 2006

  7. Today’s Presentation • Family Policy Context • Cross-national Comparative Approach • Work-Life Policies in the U.S. • Work-Life Policies in the U.K. • Gaps in Current U.S. Policies • Recommendations for Policy Change Protecting Children's Need for Nurturance 2006

  8. The Family Policy Context • Special reports of the Organization for Economic Cooperation and Development (OECD, 2002, 2003, 2004) have examined work-life policy supports in member countries. • OECD has focused on family-friendly policies which: • “Foster adequate family resources and child development…; • Facilitate parental choice about work and care, and • Promote gender equality in employment opportunity.” (OECD, 2002, Vol. 1, p. 10). Protecting Children's Need for Nurturance 2006

  9. U. S. Family Policy • The U.S. and other English-speaking countries have been characterized as adopting a liberal model of family policy (Briar & O’Brien, 2003; Esping-Anderson, 1990) : • High levels of personal choice and responsibility in work and family decisions, • Low levels of resources supporting parents including income supports and child care • Relatively high levels of poverty. Protecting Children's Need for Nurturance 2006

  10. Other Types of Family Policies • Conservative—encouraging traditional families (employed father, mother at home with young children)—Germany, Ireland, the Netherlands; • Familial—key role of extended family in providing support—Greece, Italy, Spain. • Social democratic—generous economic support of families, promotion of gender equality—Denmark, Norway, Finland, Sweden, France. Protecting Children's Need for Nurturance 2006

  11. Cross-national Comparative Approach • Comparisons can provide an impetus to improve family policies and allow parents to be both productive workers and nurturers of their children. • We focus on a comparison between the U.S. and U.K., which have both been considered as broadly “liberal” in their family policies. Protecting Children's Need for Nurturance 2006

  12. Differences in Supports for Families in U.S. and U. K. • The U.K. is moving away from the laissez faire model it had in common with the U.S. to more explicit policy aims. • The U.K. spends over 4 times the percentage of gross domestic product on cash and services for families that is spent by the U.S. (OECD, 2005). Protecting Children's Need for Nurturance 2006

  13. Work-Life Supports in the U.S. • Placing a high level of value on individual rights, few government programs have been devised to support U.S. families (Quadagno, 1994). • U.S. has developed a patchwork of programs based on pressures exerted by constituencies to meet specific needs, with a recent “devolution” of child and family supports to the state level (Kamerman, 1996). • Both universal and targeted policies have been put into place (Fredriksen-Goldsen & Scharlach, 2001) that can assist working families of children with special health care needs. Protecting Children's Need for Nurturance 2006

  14. Universal Supports in the U.S. • Family and Medical Leave • Tax Credits for Child Care • Universal Preschools and Out-of-School Care Protecting Children's Need for Nurturance 2006

  15. A. Family and Medical Leave Act • Major policy passed in 1993 allowing employees to take time off without losing their jobs • FMLA allows up to 12 weeks of unpaid leave in four circumstances: • For a newly-born child; • For a child placed with an employee in adoption or foster care; • For the employee’s own health condition; • For a spouse, child, or parent who has a serious health condition (U.S.C §2612 (a) (1) (A) – (D)). Protecting Children's Need for Nurturance 2006

  16. Many Families Not Covered by FMLA • Only covers workers in organizations with 50 or more employees within 75 miles of the employee’s worksite. • Eligible employees must have worked at least 1,250 hours for the employer in the past 12 months; part-time or seasonal workers not covered. • Some employers not covered by FMLA will allow workers to take this leave. Protecting Children's Need for Nurturance 2006

  17. FMLA Often Used for Child Illness • In 18 months prior to a 2000 survey Cantor et al (2001) found 16.5% of all employees took FMLA. • 9.8% took longest leave for child illness; • 20.1% took second longest leave for to care for ill child. • About ¼ of workers take intermittent leave, which allows workers to take leave for a few hours or days at a time, or reduce to part-time. • 39.5% of those who cared for a sick child chose intermittent leave (Cantor et al., 2001). Protecting Children's Need for Nurturance 2006

  18. Why Do Many Employed Parents Not Take FMLA? • Financial consequences are often serious; workers might have to borrow money or go on public assistance (Gerstel & McGonigle, 1999). • Some cultural groups need FMLA to care for family members not covered by the law—grandchildren, cousins, siblings– or those accepted as family (Hogan, Eggebeen, & Glogg, 1993; Stack & Burton, 1994). • FMLA can have negative employment consequences given certain organizational climates or economic downturns. Protecting Children's Need for Nurturance 2006

  19. B. Child and Dependent Tax Care Credit • Since 1997, families owing federal taxes receive a credit for expenses due to care for a child under 13 or a family member with a physical or mental disability (U.S. Internal Revenue Service, 2004). • Based on the income of parents, tax credits can range from 20-35% of their expenses for dependent care to a maximum of $3,000 for one or $6,000 for two or more dependents. • Can be used for in-home care or for centers that comply with state and local regulations. Protecting Children's Need for Nurturance 2006

  20. Child Care Tax Credit Not Available for Many Families • Most often used by middle- and upper-income parents; not available to lowest income workers (National Center for Children in Poverty, 2005). • Also not applicable to families providing care by “split shift” parenting or sibling care; often the case for children with behavioral problems (Rosenzweig et al, 2005). Protecting Children's Need for Nurturance 2006

  21. C. Universal Preschools and Out-of-School Care • Universal pre-kindergarten and before- and after-school programs are available in some states and communities; these support working families. • National Prekindergarten Study found 40,000 prekindergartens serving children from 3-4 years of age administered and partially funded by states (Gilliam & Marchesseault, 2004). • Urban Institute found that 21% of all children aged 6 through 9 participated in school-aged care programs (Capizzano, Tout, & Adams, 2000). Protecting Children's Need for Nurturance 2006

  22. Issues with Care Programs • Both universal pre-K and out-of-school programs are associated with better academic outcomes for children. • However, children with behavior problems are frequently expelled from pre-K programs (Gilliam, 2005) and excluded from after school programs. • When consultants are available, inclusion of children with emotional or behavioral problems, or special health care needs, improves (Brennan et al, 2003). Protecting Children's Need for Nurturance 2006

  23. Targeted Supports in the U.S. • Cash Assistance for Low-income Families • Child Care Subsidies • Head Start • Public Health Insurance for Children • Social Security Payments Protecting Children's Need for Nurturance 2006

  24. D. Cash Assistance for Low Income Families • Personal Responsibility and Work Opportunity Reconciliation Act of 1996 provided Temporary Assistance to Needy Families (TANF). • Parents must fulfill work requirements. • Lifetime limit of 5 years. • Increased the workforce participation of women, particularly single mothers. Protecting Children's Need for Nurturance 2006

  25. TANF Concerns • TANF participants are more likely to have disabilities or children with impairments than the general population (44% on TANF compared with 15%; GAO, 2002, p. 2). • TANF recipients parenting children with disabilities half as likely to leave welfare rolls as other participants (GAO, 2002). Protecting Children's Need for Nurturance 2006

  26. E. Child Care Subsidies • With the passage of welfare reform, congress provided state-administered subsidies through the Child Care and Development Fund for parents with lower than median income. • Some of the CCDF money is set aside for children with disabilities. • Some states exclude some forms of disabilities; the majority do not prioritize families having children with disabilities for CCDF subsidies (Brennan et al, 2001). Protecting Children's Need for Nurturance 2006

  27. F. Head Start • Head Start has been shown to be an effective program to promote social and academic readiness for low-income children (Oden, Schweinhart, & Weikart, 2000; Yoshikawa & Knitzer, 1997). • By law, Head Start requires that every site serve children with disabilities to the level of at least 10% of the enrollment, and mental health consultants are available at every site. • Because many sites are part-day and part-year, it has been difficult for Head Start parents to engage in full-time employment. Protecting Children's Need for Nurturance 2006

  28. G. Public Health Insurance • Medicaid was established in 1965 to provide families on cash assistance with free or low-cost medical care; states control access to this benefit. • In 1997, the State Children’s Health Insurance Program (SCHIP) was established to cover additional uninsured children • Coverage under these programs are subject to economic conditions; recently access has been frozen or cut back. • Many families also do not know that they are eligible for public health insurance (Centers for Medicare & Medicaid Services, 2004). Protecting Children's Need for Nurturance 2006

  29. H. Social Security Payments • The Supplemental Security Income (SSI) program supplies monthly income payments for children under 18 years of age who have disabilities, and reside with a low-income family. • Children need to (a) have a physical or mental impairment that seriously limits his or her activities; and (b) the condition must last at least one year or result in death (U.S. Social Security, 2005). • Difficult to qualify for this program; with welfare reform, the type of impairments that qualified were reduced in number and type. Protecting Children's Need for Nurturance 2006

  30. Work Life Supports in the U. K. • Major changes in the UK in the past decade… ‘unprecedented policies’ • Previously family policy was piecemeal or non-existent • Current developments • Balance rights of citizen (e.g. to receive services) and responsibilities they should shoulder (e.g. to make sure their children attend school) • In practice ‘rights’ dominate some policies and ‘responsibilities’ are more dominant in others Protecting Children's Need for Nurturance 2006

  31. Some Current U. K. Policy Features-Universal • Universal supports for working families include: • A universal child benefit payable to all, regardless of income level. • This benefit provides $30 per week for the eldest child, and $20 per week for all subsequent children. • In line with European Union emphasis on the importance of child development as a social value. Protecting Children's Need for Nurturance 2006

  32. Some Current U. K. Policy Features—Targeted • Targeted child tax credit, worth around $900 per year for about 5 million poor families (out of around 50 million people, with around 4 million single parent families [lone parents]). • Carer’s allowance of $80 per week for looking after someone with a disability (relative, friend or neighbor) if you earn less than $145 per week (and allowance for the disabled child/adult themselves). • A wide range of services, mostly low cost or free at the point of use, for children with a disability. Protecting Children's Need for Nurturance 2006

  33. The U. K. Policy Drivers • National strategies: a service framework for children covering all services. • Child care strategy, driven by the Treasury: an explicit commitment to eradicate child poverty by 2020. • Recognition that poverty blights children’s lives. • Continuing ambivalence as to whether removing this blight is because of ‘child as future worker’ or ‘child as citizen.’ Protecting Children's Need for Nurturance 2006

  34. Listening to ‘Ordinary People’ • Strong push in the U. K. for hearing the views of ordinary people in policy review and development. • Research and practice shows that these views are usually sensible and clear. • … and that people of different age, ethnicity, religion, and language can all make an excellent contribution to policy development. • They just have to be heard. Protecting Children's Need for Nurturance 2006

  35. “Universal”- FMLA available—but without pay. Child care tax credit not available to low income worker. Might have universal pre-K, or out-of-school care—depends on state and local laws. “Targeted” Not on TANF. Eligible for child care subsidies—but may not be available due to fund limitations. Head Start might be possible if full day program in their community. Public health insurance is possible—again limits on funds. SSI would require diagnosis of serious disorder. Application of the Policy Frameworks to the Morrison Family—U.S. Protecting Children's Need for Nurturance 2006

  36. Universal Eligible for child benefits at the level of $50 per week or $2,600 per year. Health care access for all adults and children. Targeted Additional $900 per year for targeted tax credit as low income parent. If earning less than $7,540 per year, carer’s benefit of $4,160 per year for taking care of Susan. Additional health care and social services and supports for Susan, individualized and tailored to her needs and Morrison Family needs. Application of the Policy Frameworks to the Morrison Family—U.K. Protecting Children's Need for Nurturance 2006

  37. Policy Priorities to Support Working Families of Children with Special Health Care Needs • Improvements in family and medical leave. • Increased supports for early childhood education and development and out-of-school care. • Specialized supports for children with health care needs in care settings. • Increased access to health and mental health services for low-income workers and their families. • Income supports for workers in low-wage jobs. Protecting Children's Need for Nurturance 2006

  38. Improvements in Family and Medical Leave • Create fund for paid FMLA. • California currently has paid family through State Disability Insurance Program. • Allow workers who are self-employed, or in smaller organizations, to pay into fund and receive paid FMLA. • Include a broader, more culturally inclusive, definition of family members who can be cared for by the worker on leave. Protecting Children's Need for Nurturance 2006

  39. Increased Supports for Early Childhood Education and Development and Out-of-school Care • Expansion of the child care development fund to cover all children with special health care needs. • Expansion access to early childhood education and out-of-school settings (e.g. full funding of Head Start; out-of-school programs in the public school system). Protecting Children's Need for Nurturance 2006

  40. Specialized Supports for Children with Health Care Needs in Care Settings • Provision of inclusion specialists and mental health consultation specialists to support child care providers as they give care to children with special health care needs. • Provision of inclusion specialists and mental health consultation specialists for out-of-school care providers. Protecting Children's Need for Nurturance 2006

  41. Increased Access to Health and Mental Health Services for Low-income Workers and their Families • More funding needs to be targeted to make sure all children have access to health care. • Parity between health and mental health care services will permit children with mental health challenges to receive the early services they need. • Ideally, all citizens should have access to health services. Protecting Children's Need for Nurturance 2006

  42. Income Supports for Working Parents in Low-wage Jobs • Finally, a fully developed family policy in the U.S. would guarantee that children would not grow up in poverty. • Parents who are able to work, and are engaged in low-wage work, should receive benefits that enable their children to develop well, despite their health and mental health challenges. Protecting Children's Need for Nurturance 2006

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