Social Policy
Program Evaluation
*Summative - evaluation to measure program results *Formative - evaluated designed to improve the intervention or methods as program develops *Serious ethical difficulties in denying services force agencies to compromise & to use alternative methods - —Quasi-scientific research —Single subject research
Gault Decision
1967 - US Supreme Court ruled that a juvenile has a right to cross examine compainants & a right to counsel & protection against self-incrimination
Boarder babies
Babies who are in hospitals because they have no families available to care for them
Social investment programs
Designed to prevent problems from developing or to promote desirable behavior (i.e., prenatal care).
SES
Determined by education, occupation, & income of head of household
Secondary prevention
Early detection & treatment (i.e., X-Ray for T.B., early intervention programs for children & families)
Medicare Part A
Hospital insurance - skilled nursing, home health, hospice care. There are deductibles or co-pays required for many services & prescription costs.
Meals for Elderly
Includes meals on wheels program & congregate meals in instituions
Traditional domains of social welfare services
Income maintenance; housing; health; education; employment; personal social services
Public housing
Initiated in 1937 - provides federal subsidies for construction of low-income public housing. Is subsidized & means-tested. Every public housing project ultimately concentrates the poorest & least successful of the poor (those whose income rises must move).
Primary prevention
Intervention before any sign of onset of a problem (i.e., parent education programs, sanitation laws)
Legal Services for the poor in civil cases
Legal services that were previously offered by the Office of Economic Opportunity & which in 1975 were replaced by the Federal Legal Services Corporation provided....
Medicaid
Medical coverage for the poor. Added to the SSA in 1965 -**COMBINED FEDERAL & STATE** program that pays for physicians & other health-related services. No contributions are required from beneficiaries. **STATES** administer the program & set policies within federal guidelines. States differ in eligibility requirements - but must cover TANF families, SSI recipients, & other poor. -One of conditions of the ACA calls on states to broaden Medicaid eligibility
Medicare Part B
Medical insurance - optional, add-on program which beneficiaries can select at additional cost provides some coverage for prescription costs Covers outpatient services including doctor's fees, typically 80%, with a patient co pay of 20% of the Medicare allowable fee. (Vs. Medicare Part A - covers in-patient hospital stays)
Minimum wage legislation
Most direct way of increasing earnings of working poor but farm & domestic workers are not necessarily covered. Liberal view is that increasing this will reduce poverty. Conservatives argue that increasing minimum wage will have paradoxical effects of increasing poverty b/c employers will reduce hiring & will not hire entry level workers
Poor Law of 1662
Obligation to provide charity first noted in this law. In the Medieval period, the church argued that there was a communal obligation to provide assistance. With the growth of towns, the communal obligation shifted to the town, & then to the state.
Julia Lathrop & Grace Abbot
Originally recommended he practice of hearing children's cases in the judge's chambers or closed court, & the use of probation services for children
Incentives
Payment from the HMO to a doctor for limiting the number of procedures, or for limiting of referrals to specialists.
Indemnity Insurance
Previously the predominant form of health insurance. Patients use any doctor or hospital, & insurance company pays some or all of the cost. Doctors/hospitals have complete flexibility when this insurance applies - no management of care by insurer.
Professional Standards Review Organizations (PSROs)
Procedures to limit costs of Medicare & Medicaid led to variety of cost control strategies: -1983 - Diagnostic related groups (DRGs) introduced to set max reimbursement rates for hospital care under Medicare. -HMOs - major providers - likely to accelerate as life span increases & medical costs rise.
Public Law 94-142
Require special services & an individual education plan for students with learning problems
Incremental change
Small changes built on each other (i.e., Medicare was passed first, later Medicaid was accepted)
Federal Older Americans Act of 1965
To improve quality of life for the elderly (better housing, employment, recreation)
Selective Programs
Type of social welfare program - available to people with certain defined characteristics. Usually income-tested (poor families, elderly poor, homeless, counseling programs, & other benefits offered after a determination of child abuse). -Provisions available to people who can't afford benefits
Carve-out
When a health care provider contracts with managed care plan to provide a particular type of care (e.g., mental health care of cancer care). A member of the managed care plan who needs psychiatric care might be sent to a contracted clinic. Members generally not aware of this.
Vocational rehabilitation
for mentally & physically disabled who have a reasonable chance of being employed - states run programs according to fed guidelines, supplemented with fed funding. Each recipient assigned a counselor to develop individualized plan.
Social policy
*Principles & procedures that guide relationships in society & are used to intervene in & regulate an otherwise random social system. All centering on fulfillment of vital social functions (laws, regulations, customs, traditions, values, beliefs, ideologies, roles, role expectations, occupations, organizations, history) —Institutions of social welfare are distinct from definitions of social policy Differing views of its functions & domains - -Redistributive - promoting equality & reducing inequality by redistributing resources & power -Network of specific functions & domains that more closely resemble traditional social services - education, personal social services, housing, health care, employment, etc. -Operate a minimal safety net of programs & supports designed to prevent individuals & families from falling below a loosely defined basic minimum standard
Managed care
-A broad term for any kind of health insurance where insurer manages or oversees the care a patient gets - as opposed to traditional "indemnity insurance" where patient goes to doctor & doctor bills the insurance company, which pays without question -Mgmt can come in many forms - insurers my require that patients start out with PCP instead of going straight to specialist. Insurers may pay PCPs to become care managers by being paid a monthly fee for each member-patient who signs up with them, instead of getting a fee for each service rendered. Patients may be required to use certain hospitals. Doctors may have to get permission from insurer re: a patient's hospital stay, surgery, or speciality care. Most common forms of managed care are HMOs and PPOs. -Represents the single biggest change in the delivery of medical care since before WWII. It affects how the government runs its Medicare & Medicaid programs, & also affects people with traditional insurance, those who pay cash, or those who receive public supported care.
Health Maintenance Organization (HMO)
-Broad term for managed care systems that provide health care services for a monthly premium. People who join them get full medical care, but only from providers that belong to their HMO. -Generally encourage or require patients to see a PCP assigned to manage the patient's care - more preventative services -Several types of HMOs **Staff-model HMO - most integrated type -doctors are full time employees of the HMO & work on salary; clinics/hospitals owned by the HMO; tend to be the largest HMOs **Group Model HMO - HMO contracts w/ groups of doctors to provide care - second most popular **IPAs - Doctors contract with HMOs to provide services - doctors may be provided a monthly fee for each member or service provided **PPOs (Preferred Provider Organizations) - Been called "managed care lite" b/c fewer restrictions - PPOs consist of doctors, hospitals, other providers who have made deal with insurer to provide patient care at reduced fee to insurer. Allow people to go to any doctor or hospital in the network for, at most, a low co-pay. May also go directly to a specialist. **Point-of-service (POS) plans - fastest growing form of managed care. Members can receive regular HMO care or be partly subsidized if want to use provider not in the HMO. **PSNs/PSOs (Provider-sponsored networks/organizations) - groups of doctors & hospitals who have joined together to offer managed care - may act like full fledged HMO, selling their services as a full-service health insurer to businesses & individuals
Block grants
-Can often be applied generally -Often increase competition between social service organizations for funds at the local & state levels of government
Personal Responsibility & Work Opportunity Reconciliation Act of 1996
-Encourages state innovations & experiments - each state varies from national model: —eliminates open-ended federal entitlements (for state reimbursement) of AFDC & creates block grant for states to provide time-limited cash assistance for needy families. Establishes a 5 year max for cash assistance to dependent families. -Makes extensive changes in child care, food stamps, SSI for kids, benefits for legal immigrants - modifications to child nutritional programs & reductions in block grant. Will reduce federal expenditures with majority of savings due to changes in Food Stamp program & reductions in benefits for legal immigrants
Social Welfare Delivery System
-Occupational (benefits provided through workplace - health insurance, disability, retirement, EAP) -Fiscal - benefits provided through tax breaks (deductions for dependents, medical deductions) -Private-market - services are purchased from profit making organizations (day-care centers, private practitioners) -Social services - services received free or on sliding scale through public or non-profit private agencies
TANF
-Provides block grants to the states -Use of block grant funds - for any "manner reasonably calculated to accomplish the purpose of Title I (TANF)". -**STATES** have complete flexibility to determine eligibility & benefit levels. -Limited to 5 year max cash assistance -Expected to provide job training & child care to unemployed mothers receiving welfare payments -If 2 parents receive fed funded child care, both parents must work, unless child severely disabled -States must deny assistance to teen if not in educational activities directed toward getting diploma or GED & if not living at home or in an approved adult-supervised setting -If parent fails to cooperate in establishing paternity or enforcing support order - state must reduce grant by 25% -Person convicted of drug-related felony - cash assistance & food stamp benefits may be denied -States may deny assistance to additional children born or conceived while parent is on welfare (FAMILY CAP). -Limited to legal resident aliens - must be a citizen (some exceptions - some refugees, asyless, lawful permanent residents w/ 40 qualifying quarters of work) -Legal immigrants - states decide to provide or deny services at their option
Child Welfare Services - Key Principles
-Safety of children = #1 concern -Reasonable efforts to preserve & reunify families are required -States not required to make efforts to keep children w/ their parents, if doing so places safety in jeopardy -Foster care = temporary setting. Not place for kids to grow up. Law shortens time frame for making permanency planning decisions & accelerates time frame for initiating proceedings to terminate parental rights. Also promotes timely adoption of kids who cannot return safely to own homes. -Permanency planning efforts should begin as soon as child enters system -Child welfare system must focus on results & accountability (annual report on state performance); creation of adoption incentive payment
Subsidized housing
1969 federal law subsidizes the difference between the operating costs of public housing & tenants' ability to pay
Demogrant
A grant to a particular demographic group that doesn't vary according to need but is a fixed amount (e.g., child allowance)
Redlining
A minority couple is unable to obtain a mortgage from a local bank. They learn that specific areas have been excluded from consideration. This practice is known as...
Redlining
A practice under which banks & insurance companies bar granting mortgages of home improvement loans in poor or declining neighborhoods
Medicare
Added to SSA in 1965 - funded partly by contributions from the elderly & by general tax revenues. Universal health program to help elderly. NOT means-tested. Covers most hospital & medical costs for people 65 and over & for disabled SS beneficiaries. Provides basic hospital insurance & optional supplementary medical insurance. Patients pay small fees to discourage unnecessary use. FEDERALLY ADMINISTERED.
Putative father
Alleged father of a child born out of wedlock
Adoption & Safe Families Act of 1997
Amends previous child welfare reform legislation; Establishes national goals for kids in child welfare system (safety, permanency, well-being). Program seeks to make system more responsive to children & families, reaffirms need for linkages between child welfare system & other systems of support for families, as well as between the child welfare system & the courts, & encourages removal of barriers that prevent permanency.
Capitation
An HMO innovation in which HMOs pay doctors/hospitals a monthly fee for every HMO member they agree to care for - whether patient spends months in hospital or no time at all. Thought to increase the incentive for preventative care.
Education of All Handicapped Children's Act - 1975
Assures all disabled kids are provided with special education & related services to meet their individual needs. Helps states to provide & evaluate their services. State agencies must provider - a comprehensive plan, identification system, & a monitoring system to ensure compliance by local education agencies Local education agencies are required to - identify & serve all kids within its area; provide due process to determine eligibility for special services; provide evaluation; provide an individualized education program IEP
English Poor Law of 1601
Basis for the principle of local responsibility for the poor in public assistance programs in the US. Became basis of welfare law - that stress government responsibility for the poor.
Foster Care Independence Act of 1999
Benefits youths who have aged out of foster care or are preparing to leave foster care. -Requires states to create job-training & college guidance programs directed to teenagers both before & after leaving foster care -States will be able to expand Medicaid coverage from 18-21 years as well as raise the personal asset level so teenagers in foster care can save for such things as car, down payment on apartment, to ensure smoother transition from foster car to independent living
Frances Piven & Richard Cloward
Book - "Regulating the Poor" - Argue that public relief stems political disorder during periods of mass unemployment & enforces low wages during periods of economic stability. Ague that welfare benefits tend to become more generous when there is a growing threat of social disruption or threat to the political order.
Settlement House Movement
Brought middle class college graduates (esp. women) into poor urban areas. Leaders sought to document the living conditions of the poor & the exploitation they experienced. They were successful in initiating numerous SOCIAL REFORMS by documenting & exposing social problems. Movement toward consumer advocacy & participation of the poor in community organization
Social Welfare Activity Characteristics
Communal provisions; promotes social stability; social investment promoting certain outcomes that are socially desirable & essential (decision to provide universal prenatal care - investment in healthy infants & mother; education - most direct form of social investment since highly educated & well-motivated workforce is important asset in promoting growth & innovation). Some programs focus on target groups who cant meet their needs by own efforts or require social welfare intervention
Family Policy
Comprehensive approach to children & families similar to that of Western European nations. Such authors including Kahn & Kamerman have suggested U.S. develop this. -Designed to protect family's ability to care for children, the elderly, & the ill - advanced in the early 80s as a policy initiative . Many western european nations have developed these policies, however, as a result of economic globalization, they too are ending abruptly & gradually eliminating certain features of these programs
Adoption Assistance & Child Welfare Act of 1980
Created network of regional centers to encourage adoption of children. Encourages alternatives to foster placement, & mandates case planning & periodic reviews. Stresses efforts to return child to home. Specifies rights of parents to be involved in case reviews, etc. —Introduced concept of Permanency Planning - policy initiative supported by Title 2e of SSA, required public child welfare agencies to establish standards of accountability & practice designed to insure that kids in placement or likely to require placement will receive services designed to insure a permanent home is found
Juvenile status offenses
Crimes that have no counterpart in the adult criminal code. Can only be committed by children - include truancy, sexual permissiveness, running away, Child in Need of Supervision (CHINS), etc.
A major objective of social work from the 1890s through WWI was social reform. After 1920, focus of social work was...
Developing individual treatment methods & expanding social work training. SW assumed the form that eventually became recognized as modern social work - shifted focus to individual treatment
Lobbying
Essential to create a climate of acceptance for policy or legislative changes. Making public statements in support of a policy by influential public officials, experts, & respected public figures. Mobilizing constituencies for lobbying campaigns (i.e,. letter writing, press conferences, demonstrations, public hearings); Influencing key decision makers for support
Settlement Law of 1662
Established a minimum period of residence before a person could establish legal settlement in a town. Under this provision, "eligibility" took its place alongside "need" as a major determinant of whether or not a person received assistance
School nutrition programs for children
Federal reimbursement provided based on all meals served, whatever children's family income. Additional assistance provided for meals served free or at reduced cost to poor children. During 1990s, programs came under congressional scrutiny - continuing efforts to reduce funding for school programs & turn over existing funding to states
Food Stamp Program
First FEDERAL program from 1939-1943, revised in 1963, & significantly expanded since 2010. -Largest federal food subsidy program - fed government & all state governments operate the program JOINTLY, providing monthly coupons based on income & family size for food purchases -Fed gov pays direct cost of food stamps & some state administrative costs -States administer program -Some states have a work requirement for childless families -Become increasingly controversial - since number of families receiving food stamps grows significantly. Now provides assistance to 40% of american families.
Community health centers
First begun under Great Society's Office of Economic Opportunity - fed funded health centers found in many low income areas. Many affiliated with hospitals & managed care organizations & offer wider spectrum of services
Title XX Social Services Block Grant
Grants to states for providing personal social services such as child welfare services & family planning. State & local governments direct the spending of block grants. Other forms of personal social services include: individual, martial, & family counseling; homemaker services; alcohol & drug abuse rehab; tenant organizing; advocacy & legal aid service; crisis hotline & walk-in services, etc.
Section 8 benefits
Housing & Community Development Act of 1974 - gives communities more opportunity to use federal block grant aid, & recipients of rent subsidies greater housing choice
Rights of mental health patients
I.e., to know reasons for admission & conditions for release; to have access to mental health laws & medical records; to have right to visitations & to refuse medications
Mental Health Reform in Middle of 19th Century
Improved treatment of the mentally ill & reform of mental institutions; Stimulated in part by Dorthea Dix - her reports on the treatment of the poor & insane lead to major reforms & improvements in care
Food stamps & Medicaid are examples of...
In-kind assistance - non-cash services are offered instead of cash assistance for the same services. They are defined as in-kind programs that have the effect of reducing the flexibility of the recipient to use the cash equivalents according to their own wishes.
Types of Social Welfare programs
Institutional programs; residual programs; universal programs; selective programs
Social Security Old Age Programs
Insurance programs rather than charity - are universal since everyone in covered occupations are eligible for benefits
Social Security Act of 1935 (SSA)
Many amendments; Provides Old Age, Survivors, Disability, & Health Insurance (OASDHI). A fed program operated by the SSA (part of Dept. of Health & Human Services). -FEDERAL program -Nation's largest social program & covers 90% of the workforce. -Employers & employees contribute to workers' Social Security retirement fund. There is a max contribution tied to a max eligible salary. -Criticism - tax is regressive - has highest impact on lower wage workers, while highest paid workers (particularly those over the soc. security max) pay at a very low rate -Under SS - basic benefit paid to a retired or permanently disabled worker is related to retirement age & level of covered earnings. -Dependents & survivors receive a proportion of the benefit with a family maximum. Eligibility for old-age benefits is NOT means-tested. -Survivors' insurance - paid to surviving minor kids (& those still in school & under 22) & surviving parent, & to dependent parents of a deceased worker -Disability insurance - paid to disabled adults who are unable to work. -Unemployment insurance (UI) - originally passed in 1935. Employers contribute to state unemployment fund that benefits workers who are dismissed. Benefits vary from state to state. Benefits are time-lmited (~26 weeks) -Workmans' comp - social insurance program providing cash & medical benefits to workers who are injured on job. State operated & coverage varies. (paid for out of insurance premiums paid by employers) ——benefits include reimbursements for medical care & rehabilitation -SSI (Supplemental Security Income) - 1972 - program for certain categories of the poor: the aged, blind, & disabled. Administered by federal agency - so eligibility requirements same across all states. Many states add small cash supplements to the gov's minimum payments. -Aid to Families with Dependent Children (AFDC) - replaced in 1996 by TANF - determined by states
Medicare vs. Medicaid
Medicare - an entitlement program for the elderly & disabled; administered by the FEDERAL government Medicaid - administered by STATE governments & designed for the medically indigent **Both are authorized under social security act
Medicare Part D
Medicare prescription drug insurance (2006) program replacing existing drug plans, either as an add-on to the government's traditional fee-for-service or as part of a comprehensive managed care plan. Most limit what meds are covered. (i.e., doesn't include meds to promote fertility, meds used for weight loss/weight gain, drugs used for symptomatic relief of coughs & colds, etc.)
Negative Risk Factors
Most useful in determining factors that differentiate those in poverty from those outside. Characteristics considered in measuring negative risk factors include income, health, education, housing, & employment. For ex., someone living in a poor neighborhood, in inadequate housing, & attending a substandard school is at higher risk of remaining poor & contracting certain illnesses than someone from a more enriched environment.
Bill of rights for the Handicapped
Part of Rehabilitation Act of 1973 - to integrate disabled people into society. All federally subsidized programs & facilities must have affirmative action programs to hire, promote, & not discriminate against qualified disabled persons & provide access
Child Abuse Prevention & Treatment Act of 1974
Requires states to mandate reporting of child abuse & neglect. All states have relatively similar reporting laws, but some variations in who has to report. -All social workers mandated to report suspected incidents - just need to believe there's reasonable cause to believe it is occurring
Gag rules
Rules in HMO contracts that limit what doctors can say to their patients. Some contracts say doctors cannot question the truth/validity of an HMO. Some prohibit doctors from informing patients about medical services that are not covered by the HMO.
SS vs. SSDI vs. SSI
SS - age-based; not based on disability SSI - disability income regardless of work history SSDI - federal needs based benefits requiring about 10 years of work history
Managed care mental health coverage
Some states require prescribed level of mental health coverage. Most plans have lower lifetime limits for mental illness vs. physical illness. Some plans provide parity.
Women, Infants, & Children (WIC)
Special Supplemental nutrition program operated by Food & Nutrition Services of the Dept. of Agriculture through local agencies & health clinics. Pregnant & nursing women & children to age 4 with nutritional problems are given foods high in important nutrients (milk, cereal, eggs)
Moynihan Report
The 1965 report that described Black youth as trapped in a "tangle of pathology," crime, & school & work failure resulting from the destruction of the Black family. Argued that Black families suffered from instability, a propensity to produce illegitimate children, & a matriarchal structure that produced harmful effects, particularly on boys. The report was controversial in its own time & led to racism accusations.
Health Maintenance Organizations (HMOs) vs. fee-for-service
The HMO act offers federal assistance to independent organizations providing comprehensive health care for those enrolled. Members pay fees that enable them to care. Many communities (under pressure from fed policy makers) currently emphasizing managed care as a solution for providing health services. Remains the fastest growing sector of the health industry. -Can deny expensive treatments in some instances (enacted minimum hospital stays for childbirth) Major reason for advocating for HMOs is their ability to provide services more efficiently than fee-for-service. As a result, can generally offer more services for the same fees as indemnity insurers.
The Culture of Poverty
The theory that the poor are unable to escape from poverty because they have learned & integrated behaviors & attitudes from the community & the family environment.
Exceptional Eligibility Programs
Those that establish services or benefits for individuals in a special grouo, even though some of the members do not have special needs. (veterans programs, affirmative action programs)
Tertiary prevention
Treatment in the acute phase (e.g., antibiotics to treat T.B., foster care for abused children)
Institutional programs
Type of social welfare program - Provided by government - available to ALL societal members & have broad, inclusive eligibility criteria; universal; some not means tested - i.e., social security old age, disability & widows pensions, public education, most public health programs). -Institutional view that social services are central function of the society & must be available to all, not just for emergencies or abnormalities in individual, family, or community functioning. Services are not only rehabilitative but developmental & preventative. Geared toward helping people reach their fullest human potential. -Not means-tested & carry no stigma (universal day care, child-development programs, social security retirement, increased access to medical insurance - more recently).
Universal programs
Type of social welfare program - programs available to everyone regardless of income. Non-means tested (e.g., public education, social security, negative income tax, disability insurance, unemployment insurance). -Have significant political insurance against winds of policy change. Once established, they unify diverse political groups since everyone benefits. Difficult to mobilize opposition to these programs & opponents are often defeated.
Residual programs
Type of social welfare program - provided when the market/family/community (church, private charity) isn't equipped to provide necessary assistance. -Means-tested (i.e., TANF, Medicaid). -AKA - safety net -Often inflict a stigma (TANF, child protection, hospitalization of the mentally ill) -Smallest unit of services/benefits to insure basic survival
Lesser Eligibility
Welfare grants should not be higher than the lowest paying job in society; Cloward & Piven note that the principle represents a way to control labor & to maintain incentives for workers to accept low-paying or undesirable jobs that they might otherwise reject. Concept of less eligibility derives from Elizabethan Poor Law & suggests economic & wage issues underpin the size of benefits & the availability of welfare
Adverse Selection
When insurers recruit the healthiest people & avoid insuring people with serious & costly existing conditions. Insurers can be more profitable & maintain lower costs to insureds by insuring healthy people. Some states have laws against overt adverse selection but can be subtle, like showing only young healthy people in advertisements, making sicker people believe they are not eligible. Sometimes referred to as "cherry picking."