Trauma-informed Temporary Assistance for Needy Families (TANF): A Randomized Controlled Trial with a Two-Generation Impact
Trauma-informed Temporary Assistance for Needy Families (TANF): A Randomized Controlled Trial with a Two-Generation Impact
Layla G. Booshehri 0 1
● Jerome Dugan 0 1
● Falguni Patel 0 1
● Sandra Bloom 0 1
● Mariana Chilton 0 1
0 Dornsife School of Public Health, Drexel University , 3600 Market Street, 7th Floor, Philadelphia, PA 19104 , USA
1 College of Nursing & Health Professions, Drexel University , 1601 Cherry Street, Philadelphia, PA 19102 , USA
2 Mariana Chilton
Temporary Assistance for Needy Families (TANF) has limited success in building self-sufficiency, and rarely addresses exposure to trauma as a barrier to employment. The objective of the Building Wealth and Health Network randomized controlled trial was to test effectiveness of financial empowerment combined with trauma-informed peer support against standard TANF programming. Through the method of single-blind randomization we assigned 103 caregivers of children under age six into three groups: control (standard TANF programming), partial (28-weeks financial education), and full (same as partial with simultaneous 28-weeks of trauma-informed peer support). Participants completed baseline and followup surveys every 3 months over 15 months. Group response rates were equivalent throughout. With mixed effects analysis we compared post-program outcomes at months 9, 12, and 15 to baseline. We modeled the impact of amount of participation in group classes on participant outcomes. Despite high exposure to trauma and adversity results demonstrate that, compared to the other groups, caregivers in the full intervention reported improved self-efficacy and depressive symptoms, and reduced economic hardship. Unlike the intervention groups, the control group reported increased developmental risk among their children. Although the control group showed higher levels of employment, the full intervention group reported greater earnings. The partial intervention group showed little to no differences compared with the control group. We conclude that financial empowerment education with traumainformed peer support is more effective than standard TANF programming at improving behavioral health, reducing hardship, and increasing income. Policymakers may consider adapting TANF to include trauma-informed programming.
TANF ● Randomized controlled trial ● Two- generation ● Depression ● Trauma
Introduction
The Temporary Assistance for Needy Families program
(TANF) is meant to help low income caregivers gain
employment skills, secure employment and reach
selfsufficiency. However, after 20 years of research on the
impacts of TANF, it is clear that it falls short of helping
people enter the workforce and stay there, and that TANF
participants have serious behavioral health challenges that
affect their ability to reach self-sufficiency
(Bryner and
Martin 2005; Dworsky and Courtney 2007; Martin and
Caminada 2011)
. In order to receive TANF, caregivers with
young children under age six are required to participate in
20 “work hours” per week that may include job search,
training, or other programming. However, evidence shows
that the majority of such programs do not address the
wellbeing of families, nor are there incentives to help caregivers
find steady well-paying opportunities
(Corcoran et al. 2004;
Danziger 2010; Hildebrandt and Stevens 2009; Kaplan et al.
2005)
. In many instances, TANF participants may get jobs,
but do not succeed in keeping them, only to return to TANF
again
(Hildebrandt and Kelber 2012; Hildebrandt and
Stevens 2009; Ziliak 2014)
.
Almost one third of TANF recipients have a
worklimiting health condition, and high rates of exposure to
violence and adversity in their families and communities
(Cheng 2013; Kennedy 2006; Lown et al. 2006)
. Adverse
childhood experiences (ACEs) consisting of physical and
emotional abuse and neglect, sexual abuse, and household
dysfunction, such as having a household member in prison
or witnessing domestic violence, are especially prevalent
among those receiving TANF
(Cambron et al. 2014)
. The
original ACEs studies were conducted at Kaiser Permanente
in Southern California in two waves of data collection of
over 17,000 members of their Health Maintenance
Organization, where adverse childhood experiences reported by
survey respondents were compared with current health
status and behaviors
(Anda et al. 2006; Felitti et al. 1998)
.
Since then additional research studies have linked ACEs to
work-limiting conditions such as depression, cardiovascular
disease, autoimmune diseases, and food insecurity, while
damaging work prospects and stable income
(Adams et al.
2013; Anda et al. 2008; Breiding et al. 2014; Cambron et al.
2015; Chilton et al. 2015; Danese et al. 2009; Dube et al.
2009; Staggs et al. 2007)
. High exposure to adversity
among TANF-eligible caregivers also has crippling effects
for academic achievement, parenting, employment, and
executive functioning capabilities
(Evans et al. 2011; Liu
et al. 2013; L (...truncated)