Policies Supporting Working Families Having Children with Special Health Care Needs: A Transnational

1
Policies Supporting Working Families Having
Children with Special Health Care Needs A
Transnational Comparison

• Presented at
• Protecting Childrens Need for Nurturance Proven
  Strategies and New Ideas
• March 23, 2006
• Oregon Child Advocacy Project
• Eugene, Oregon

2
Eileen M. BrennanGraduate School of Social
WorkPortland State University,
U.S.A.AndPeter MarshDepartment of
Sociological StudiesUniversity of Sheffield,
United Kingdom
Todays presentation is based on a paper written
by
3
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
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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).

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Maintaining Employment Difficult While Meeting
Childrens 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 childrens 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).

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The Morrison Family

• Susana 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.
• Jeanneher single mother has had difficulty
  maintaining employment given Susans care needs,
  and her responsibilities to Susans older sister,
  and is worried about losing her job and her
  insurance altogether.
• Support sources the family is supported by
  Jeannes mother and neighbor, but this support is
  wearing thin.

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Todays 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

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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).

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U. S. Family Policy

• The U.S. and other English-speaking countries
  have been characterized as adopting a liberal
  model of family policy (Briar OBrien, 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.

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Other Types of Family Policies

• Conservativeencouraging traditional families
  (employed father, mother at home with young
  children)Germany, Ireland, the Netherlands
• Familialkey role of extended family in providing
  supportGreece, Italy, Spain.
• Social democraticgenerous economic support of
  families, promotion of gender equalityDenmark,
  Norway, Finland, Sweden, France.

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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.

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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).

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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.

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Universal Supports in the U.S.

• Family and Medical Leave
• Tax Credits for Child Care
• Universal Preschools and Out-of-School Care

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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 employees own health condition
• For a spouse, child, or parent who has a serious
  health condition (U.S.C 2612 (a) (1) (A) (D)).
  

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Many Families Not Covered by FMLA

• Only covers workers in organizations with 50 or
  more employees within 75 miles of the employees
  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.

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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).

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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 lawgrandchildren,
  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.

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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.

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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).

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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).

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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).

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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

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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.

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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).

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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).

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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.

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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 Childrens 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).

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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.

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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

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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.

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Some Current U. K. Policy FeaturesTargeted

• 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).
• Carers 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.

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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 childrens
  lives.
• Continuing ambivalence as to whether removing
  this blight is because of child as future
  worker or child as citizen.

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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.

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Application of the Policy Frameworks to the
Morrison FamilyU.S.

• Universal-
• FMLA availablebut without pay.
• Child care tax credit not available to low income
  worker.
• Might have universal pre-K, or out-of-school
  caredepends on state and local laws.

• Targeted
• Not on TANF.
• Eligible for child care subsidiesbut may not be
  available due to fund limitations.
• Head Start might be possible if full day program
  in their community.
• Public health insurance is possibleagain limits
  on funds.
• SSI would require diagnosis of serious disorder.

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Application of the Policy Frameworks to the
Morrison FamilyU.K.

• 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, carers
  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.

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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.

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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.

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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).

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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.

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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.

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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.