Major changes to the U.S. welfare system since 1996 have resulted in significant reductions in Temporary Assistance to Needy Families (TANF, or 'welfare') assistance to predominantly poor, minority women by moving them into low-wage jobs through 'welfare-to-work', or welfare transition programs (WTPs). Studies have documented that 30% re-enter the program within one year of exit due to difficulty maintaining employment, and one factor driving 're-entry1 is the extremely high prevalence of chronic health conditions in this group. Our data, and data from others, suggests current approaches for addressing health problems among women in WTPs are woefully inadequate, and will result in neither reducing health disparities nor improve their ability to meet self-sufficiency goals. Studies to improve the health of women receiving TANF are absent, despite clear and compelling evidence they suffer from higher rates of health problems than women in both the general population and other low-income women, and that little is being done in WTPs to meet their health needs. Thus, this study is necessary to improve the health of this group; it is also hovel, in that the intervention is based on the needs and preferences of WTP participants themselves.
The specific aims of this research are: 1. To redesign the current WTP clinical health screening tool so that it is culturally relevant, sensitive, and acceptable for use in testing the efficacy of a Welfare Participant-Centered Health Program (WPCHP) using a participatory research methodology. 2. To test the efficacy of a WPCHP in: a) increasing rates of voluntary screening, identification, and treatment for chronic health conditions, b) increasing the knowledge and skills necessary to navigate the Medicaid system, c) improving functional and health status over time, and d) increasing employment duration among women enrolled in WTPs with chronic health conditions using a participatory research methodology.
