HUSR 475

General Assistance Programs

(GA) programs, also known as General Relief programs in some states, are cash and in-kind assistance programs financed and administered entirely by the state, county, or locality in which they are located. These programs of last resort are designed to meet the short-term or ongoing needs of the severely poor without children, who are ineligible for (or awaiting approval for) mainstream federally funded programs, such as TANF or SSI. In many ways, GA programs serve some of the poorest of the poor.

Medicare

-After Social Security, Medicare is the largest social insurance program in the United States with expenditures of $748 billion in 2014.16 It is also the largest public payer of health care, financing close to 20 percent of all health care spending. Medicare was added to the Social Security Act in 1965 and was designed to provide elderly people with prepaid hospital and optional medical insurance. -The modern Medicare system is composed of four parts: compulsory Hospital Insurance (HI), known as Part A; Supplemental Medical Insurance (SMI), known as Part B; the Medicare Advantage program, known as Part C; and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, known as MMA or Part D. Although traditionally consisting of two parts (HI and SMI), Part C (established by the Balanced Budget Act of 1997) expanded beneficiaries' options for participation in private-sector health care plans. The MMA or Part D was added in 2003. -Medicare payments for most inpatient hospital services are made under a reimbursement mechanism known as the prospective payment system (PPS). Under PPS, a predetermined amount is paid for each inpatient hospital stay based on a diagnosis-related group classification.

Chapter 13 Mental Health and Substance Abuse Policy NATIONAL MENTAL HEALTH ASSOCIATION

-Begun early in the twentieth century, the National Mental Health Association (NMHA) pioneered efforts to provide social support and treatment for the mentally ill. NMHA was frequently critical of the custodial institutions operated by state governments. For instance, during the Progressive Era, the eugenics movement contributed to the institutional abuses that were condemned by NMHA. - Approved by the Supreme Court in the 1927 case Buck v. Bell, in which the critical determination of Carrie Buck's social degeneracy was made by a social worker, 65,000 Americans would ultimately be sterilized involuntarily.2 Many patients, of course, lacked the mental capacity to comprehend sterilization and had no idea that the surgical procedures to which they were subjected would terminate their ability to reproduce. The laws that enabled NIMH to reform mental health care were the Community Mental Health Centers Acts of 1963 and 1965.

The War on Drugs

-By the 1980s, events had propelled the control of drug abuse to a top priority in U.S. criminal justice. The deterioration of inner cities had been accompanied by an alarming degree of social dysfunction. Illegal drugs were not only prevalent in the poorest minority neighborhoods but had also become an essential, if not the predominant, part of the local economy. -Two strategies dominated the War on Drugs: government interdiction of supplies, aimed at eliminating the substance, and treatment programs deployed to diminish the demand for illegal drugs.

Chapter 15 Child Welfare Policy

-Child protective services, foster care, adoption, and Head Start have been the focus of child welfare policy since the 1960s -The low ranking of the United States can be attributed to two factors: the high incidence of poverty among American children and the absence of universal health care for their families -One-fifth of children in the United States live in poverty, a condition that is associated with inadequate nutrition and shelter. In addition, one-third of children lack access to health care due to absence of health insurance, which may improve due passage of the Affordable Care Act. By contrast, nations ranking higher than the United States make more financial benefits available to families, and health care is universal providing all children access to health care.

The Underclass and "Moral Poverty"

-Conservatives argued that the chronic poor suffered from problems qualitatively different from those of the temporarily poor. -The conservative prescription for moral poverty relied extensively on incarceration, especially recidivists, evident in "three strikes" laws and mandatory minimum sentences. Following conservative thinking that contributed to passage of welfare reform in 1996, Bennett, DiIulio, and Walters advocated reinforcing work as opposed to unconditional welfare, removing young children from dysfunctional homes, and encouraging adoption as an alternative to foster care.

TYPES OF MANAGED CARE

-Health Maintenance Organizations (HMO)— a prepaid or capitated insurance plan in which individuals or their employers pay a fixed monthly fee for services rather than a separate charge for each visit or service. -

Protective Services for Children

-In the 1960s, reports of child maltreatment increased as a result of advances in radiological technology. A pediatrician, C. Henry Kempe, identified non-accidental injuries to children as the battered child syndrome -As a result of these national standards, the NCCAN was able—for the first time—to report trends in child abuse and the need for protective services for children. Alarmingly, the data collected by NCCAN revealed a dramatic increase in reports of child abuse, more than doubling between 1976 and 1986, when reports of child abuse numbered 2 million. Reports of child abuse continued to climb through the mid-1980s, while at the same time expenditures for child protective services were decreasing

Foster Care for Children

-States adopted separate policies and, unfortunately, took few measures to monitor children in foster care. During the early 1960s, a series of studies began to document a disturbing development: Rather than being a temporary arrangement for child care, foster care had become a long-term experience for many youngsters, with 70 percent of children in foster care for more than one year. -Not only had states planned poorly for the reunification of children with their original families, but also in many instances child welfare agencies lost track of foster care children altogether. In response to the deterioration of children's services, permanency planning became a central feature of the Adoption Assistance and Child Welfare Act (AACWA) of 1980. As a result of permanency planning, the number of children in foster care plummeted from 330,400 in 1971 to 262,000 in 1982, a reduction of 20.7 percent. Welfare workers swiftly removed children from foster care and reunited them with their biological families under the rationale that community support services would assist parents. -

Assumptions and Myths about Public Assistance

-Temporary Assistance to Needy Families (TANF): a block grant based on workfare, time-limited benefits (a maximum of 5 years), and strict work participation rates. -Supplemental Security Income (SSI): provides cash assistance to the impoverished elderly and the disabled poor, including children. -General Assistance (GA): state or locally run programs designed to provide basic benefits to low-income people who are ineligible for federally funded public assistance programs. -Supplemental Nutrition Assistance Program (SNAP): Originally known as the Food Stamp Program and renamed in 2008 The program provides benefits to low-income households for food assistance.

Uninsured

-The uninsured are more likely than the privately insured to not receive needed medical care and more likely to need hospitalization for avoidable acute conditions like pneumonia or uncontrolled diabetes. -Uninsured children have a higher instance of developmental delays than those with health coverage -Uninsured adults hospitalized for heart attacks are 25 percent more likely to die while in the hospital than privately insured adults. -The diagnosis of a serious new health condition, including cancer, diabetes, heart attack, chronic lung disease, or stroke, reduced the wealth of uninsured households by 20 percent. -Americans who lack health insurance cost the economy billion a year in lost productivity.7 The cost of medical care for the uninsured totaled almost $85 billion in 2013

Adoption

-To reinforce the cultural identity of Native American children, the Indian Child Welfare Act provided for "minimal Federal standards for the removal of Indian children from their families and the placement of such children in foster or adoptive homes which will reflect the unique values of Indian culture, and for assistance to Indian tribes in the operation of child and family service programs." -The National Association of Black Social Workers (NABSW) advanced a similar argument for culturally appropriate placement of children during the 1980s, noting a high percentage of African American children placed with white families.

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996

A basic principle underlying the PRWORA was the transference of responsibility for managing social programs from Washington to the states. Promoted early by the Reagan administration, this ideological perspective has been labeled the "devolution revolution" or the "new federalism." Energized by the cry of "states' rights," the new federalism traded off long-term stable federal funding for increased state control through block grants. In 1996, former President Bill Clinton signed the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) The PRWORA was predicated on a form of welfare behaviorism—an attempt to reprogram the behaviors of the poor. Despite data demonstrating the marginal economic benefits of making welfare conditional, conservatives effectively leveraged a moral argument that public policy should change the behavior of the welfare poor.

Which of the following statements are used to support the argument for the legalization of drugs?

A. By legalizing drugs, substantial sums of money would be freed from law enforcement and could be channeled to prevention and treatment programs. b. Destigmatization of drug abuse could mean that more drug abusers enter treatment. c. All of the above are true. d. Prison populations would be cut significantly. ANSWER-c. All of the above are true.

AFDC

AFDC was designed to provide financial assistance and care to needy dependent children in their own homes or in the homes of responsible caregivers. Despite these modest goals, AFDC served as a symbol in the ideological battle between liberals and conservatives and caused recipients to be victimized in two ways: (1) by their own poverty and (2) by ideologically motivated assaults upon their character and motives. Originally called Aid to Dependent Children (ADC), the AFDC program was part of the Social Security Act of 1935 and was designed to provide support for children by dispensing aid to their mothers. In 1950, the adult caregiver (usually the mother) was made eligible for ADC benefits.28 Also in the 1950s, medical services paid for in part by the federal government were made available for ADC recipients. Beginning in the late 1950s, some critics argued that ADC rules led to desertion by fathers, because only families without an able-bodied father were eligible. In 1961, a new component was added that allowed families to receive assistance in the event of a father's incapacity or unemployment. The new program, Aid to Families with Dependent Children-Unemployed Parent (AFDC-UP), was not made mandatory for the states, and until the welfare reform act of 1988, only 25 states and the District of Columbia had adopted it. In 1962, ADC was changed to AFDC to emphasize the family unit.

History of U.S. Child Welfare Policy

Although many states established orphanages during the eighteenth century, current child welfare policy in the United States has its origins in the 1870s -In 1874, a New York church worker, Etta Wheeler, discovered that an indentured nine-year-old child, Mary Ellen, was being tied to a bed, whipped, and stabbed with scissors. On investigating what could be done for Mary Ellen, Wheeler spoke with the director of the New York Society for the Prevention of Cruelty to Animals (NYSPCA) on behalf of the child.

Alcohol Abuse

Americans steadily increased their consumption of alcohol from the end of World War II until the 1980s, when drinking began to decrease. By 2013, average per capita consumption was a little more than 2.3 gallons of wine, 1.5 gallons of spirits, and 20.7 gallons of beer a year. However, that amount was not evenly distributed throughout the population. One-third of the adult population abstains from alcohol consumption, one-third of people who do drink consider their consumption to be light, and the remaining third are considered moderate to heavy drinkers. The 2013 National Survey on Drug Use and Health revealed that 60.1 million Americans were binge drinkers on occasion and that 16.5 million were heavy drinkers.

Which statement does NOT accurately describe boot camps for juveniles?

An analysis of boot camps concluded that alumni were less likely to commit future offenses.

Costs

As noted earlier, more than 31 percent of all health care expenditures in 2015 went toward hospital costs. The total costs of hospital care reached $972 billion in 2014, up from $27.2 billion in 1970. According to the American Hospital Association, nearly 60 percent of hospital costs go to wages and benefits of caregivers and others. The costs of technology, construction, and regulatory compliance account for a growing share of hospital costs.

The Children's Health Insurance Program (CHIP)

As part of the Balanced Budget Act of 1997, Congress enacted the State Children's Health Insurance Program (S-CHIP), a federal-state partnership that allocated $48 billion over 10 years to expand health care coverage to low-income, uninsured children under age 19 who are ineligible for Medicaid. As part of the eligibility requirements, children generally must be below 200 percent of the federal poverty level. In 2010, $11.4 billion was spent on CHIP. By 2015, over 8 million children were enrolled in the CHIP program.47

The New Jim Crow

Because minorities of color have been disproportionately incarcerated, race and ethnicity have been fundamental to understanding criminal justice. After the Civil War, the passage of "Jim Crow" laws intended to deny African Americans their civil rights, institutionalized racism in public policy for a century and, in the process, subjugated Blacks. Recently, the disconnect between a falling crime rate and yet increasing incarceration of African Americans led a black attorney, Michelle Alexander, to conclude that the prison system replicated a caste system that permanently marginalized minorities, not unlike slavery. -Following this logic, the association between incarceration, social disadvantage, and dropping out of high school is striking. "More than half of all black men without a high school diploma go to prison at some time in their lives,

Medicaid

Before 1965, medical care for those unable to afford it was primarily a responsibility of charitable institutions and state and local governments. In 1950, the federal government authorized states to use federal/state funds under the Social Security Act of 1935 to provide medical care for the indigent. In 1957, the Kerr-Mills Act provided for a federal/state matching program to provide health care for the elderly and the poor. However, Kerr-Mills was not mandatory, and many states chose not to participate. As a compromise to ward off more far-reaching health reforms, former President Lyndon Johnson signed into law the Medicaid and Medicare programs in 1965. Replacing all previous governmental health programs, Medicaid became the largest public assistance program in the nation. The 2014 expenditures for Medicaid was $492.3 billion.

Post-Traumatic Stress Disorder

Between 1999 and 2004, for example, claims for PTSD increased 79.5 percent, accounting for one-fifth of all compensation benefits. As these wars wound-down, 195,000 veterans had been screened for TBI, the majority of which rated as mild to moderate in severity Equally disturbing, the incidence of suicide among members of the uniformed services increased. In 2010, 295 service members took their own lives; 48 percent having visited military treatment prior to suicide.

The Advent of Psychotropic Medication

By 2000, the Justice Department reported that 283,800, or 16 percent, of inmates in local and state correctional facilities suffered from mental disorders and another 550,000 were on parole In 2003, Human Rights Watch reported that U.S. prisons contained three times more psychiatric patients than mental hospitals. This institutional mismatch had come to the point that the largest psychiatric facility in the nation was the Los Angeles County Jail, which held 3,400 mentally ill inmates; second was New York's Rikers Island with 3,000 mentally ill inmates. In 2007, the Supreme Court ruled in Panetti v. Quarterman, that offenders must have a "rational understanding" of the state's plan to be executed.23

Drug Abuse

By contrast with alcohol abuse, the prevalence of drug abuse is more difficult to ascertain because the use of controlled substances—the focus of drug abuse—is illegal. It appears that general drug abuse has begun to decline after peaking during the 1979 to 1980 period. In 2006, almost 20.4 million Americans reported use of illicit drugs, a significant decrease from the 25 million abusers estimated in 1979 (see Table 13.5). Among younger Americans aged 12 to 17, drug abuse has been declining (from 11.6 percent in 2002 to 8.8 percent in 2013); drug abuse by young adults aged 18 to 25 increased somewhat (from 20.2 percent in 2002 to 21.5 percent in 2013). Drug abuse has changed little during the past decade; most illegal usage might be categorized as "recreational" as contrasted with addictive "hard" drugs, as evident in SAMHSA's 2013 survey of drug usage.

Emerging Issues in Child Welfare

DAY CARE: Day care for children has risen in importance as more and more parents with children work. In 1947, only 12 percent of mothers with children under age six worked outside the home, but by 2002 this became 64.1 percent MATERNAL AND CHILD HEALTH The primary federal program to enhance prenatal care for low-income families is WIC, the Special Supplemental Nutrition Program for Women, Infants, and Children. Under WIC, low-income pregnant and nursing women and their young children are eligible for food coupons through which they may obtain especially nutritious foods. Even though the WIC program would seem a logical method for addressing the low-birth-weight problem of infants born to poor women, participation in the WIC program is not at desirable levels. TEEN PREGNANCY: The Guttmacher Institute reported that the teen pregnancy rate for 2010 had declined 51 percent from its highest in 1990. Yet, teen parenthood remains a significant problem: in 2010, 367,678 teens became mothers.

Deinstitutionalization

Deinstitutionalization was further confounded by a series of judicial decisions in the mid-1970s that enhanced the civil rights of mental patients while at the same time requiring states to provide them with treatment. In Wyatt v. Stickney, Alabama District Court judge Frank Johnson ruled that the state of Alabama was obliged to provide treatment to patients in state hospitals, a judgment with which the state subsequently failed to comply. Shortly thereafter, in Donaldson v. O'Connor, the Supreme Court determined that "the state could not continue to confine a mentally ill person who was not dangerous to himself or others, who was not being treated, and who could survive outside the hospital." Finally, in Halderman v. Pennhurst, the Third District Court established that institutionalized patients deserved treatment in the "least restrictive alternative."

In the early to mid-1800s, which of the following did NOT contribute to the lack of support for humane institutions?

Dorothea Dix and her reform movement

Legalization of Drugs

Drug legalization had been a standard demand among Libertarians, who argued that individuals should be free to engage in any activity so long as it does not harm others. They contended that the current policy was little more than a replication of Prohibition's futile effort to ban alcohol from American culture

Modern criminology dates from the

Enlightenment.

Health Care

Health care in the United States is marked by several contradictions. According to Census Bureau data, the number of people with health insurance rose to almost 87 percent in 2014; however, more than 13 percent or 33 million people were without health. Of that number, 8.6 percent of all children were uninsured. The percentage of the nation's population covered by government health insurance programs (e.g., Military, Medicaid, and Medicare) was at 40 percent in 2014.1 The medically uninsured have the following characteristics:

The Health Care Crisis

Health care in the United States is plagued with problems such as eroding coverage, rising and shifting costs, and an increasing number of anxious citizens fearful about getting and keeping health insurance.

Head Start

In response to concerns about the lack of educational preparation of poor children, Head Start was incorporated in the Economic Opportunity Act of 1964. The first Head Start programs were established in poor communities a year later. Intended to compensate for a range of deficits displayed by poor children, Head Start offered health and dental screening, nutrition, and socialization experiences in addition to preschool academic preparation. Of the Great Society programs, Head Start was one of a few that captured the imagination of the nation. Despite wide public support, however, participation in Head Start was uneven. Significantly, it was not until 1995 that the enrollment of Head Start eclipsed that of 1966; today, fewer than half of eligible children participate in the program

Chapter 14 Criminal Justice History of U.S. Criminal Justice

Modern criminology dates from the Age of Enlightenment in the eighteenth century and its notion that humankind was capable of producing the methods for its own perfectibility.

The Patient Protection and Affordable Care Act

On March 23, 2010, former president Barack Obama signed into law the 2,000-page Patient Protection and Affordable Care Act (ACA). This legislation was incremental—yet in some ways also comprehensive—and was based on an NHI model that required everyone to be covered by a health care plan. In particular, the legislation extended coverage to the 32 million people in 2010 without health insurance coverage. The ACA contained the following features: 1. Enrollment and Employer Requirements: 2. Cost and Funding 3. Health Insurance Exchanges (HIE) 4. Subsidies 5. Regulation of the Health Insurance Industry: 6. Public Health 7. Medicare: 8. Medicaid 9. Abortion

Police Violence

Police misconduct has been addressed through several strategies. Police civilian review boards have been established in several cities, although police tend to oppose such oversight. Improved training of police with regard to non-lethal apprehension of suspects, especially the inebriated and mentally ill has also been undertaken.

The Prison Industrial Complex

Since the mid-1980s, the United States witnessed a significant increase in prison construction, the passage of new laws requiring incarceration of repeat offenders, and the reinstitution of capital punishment in some states. Approaching the end of the twentieth century, the United States boasted an incarcerated population that exceeded 2 million ; during 2010, the total number of people under the supervision of correctional authorities reached 7.1 million. In 1970, the number of inmates in state and federal correctional facilities was 96.7 per 100,000 population; by 1993, the number had more than tripled, to 352.9; by 1997, it had more than quadrupled, to 445.61 In 1994, the Violent Crime Control and Law Enforcement Act introduced the "three strikes" penalties for repeat offenders and increased the number of federal crimes to which the death penalty applied.62 The number of prisoners under the death sentence soared. In 1980, 688 inmates were on death row; by 2000, the number had increased fivefold to 3,593.63 Of these, 43.7 percent were nonwhite64; the number of people of color with death sentences was thus more than double their proportion of the general population.

FSA

The Family Support Act (FSA) of 1988 was an important piece of welfare legislation.30 The FSA (budgeted at only $3.3 billion over a five-year period) attempted to change AFDC from an income support to a mandatory work and training program.

The National Center for Health Statistics

The National Center for Health Statistics (NCHS) is a key resource of information about the health of Americans. As the principal health statistics agency in the United States, the organization compiles statistical information to guide action and policies to improve the health of people living within the United States.

SSI SUPPLEMENTAL SECURITY INCOME

The SSI program began during the Nixon presidency as a substitute for a number of state-operated disability programs. When Richard Nixon took office in 1972, he attempted to streamline the welfare system by proposing a guaranteed annual income that would replace various income maintenance and disability programs. Although Congress rejected the overall plan, various disability programs were federalized in 1972 under a new program—SSI—with the federal government taking over the operation of those programs from state governments. In 1974, there were 3.25 million SSI recipients; by 2009, that number had more than doubled to almost 8 million. Concomitantly, SSI expenditures increased from $5 billion in 1974 to more than $48 billion in 2010

The Criminal Justice System

The U.S. criminal justice system is similar to education, and mental health programs in that states and localities provide a significantly larger portion of services than the federal government. The Constitution reserves public functions to the states unless they are ceded to the federal government; in the case of criminal justice, this means that state and local government expenditures exceed those of the federal government by a factor of four.7 Between 1980 and 2003, criminal justice expenditures increased 417.5 percent.8 Moreover, there was considerable variation in state expenditures. In 2007, for example, the per capita cost of criminal justice in the District of Columbia was $1,373; that of nearby West Virginia was $412.9 Such cost disparity encourages higher-cost correctional systems to contract-out incarceration with lower-cost systems; however, this contravenes family life when urban inmates are housed in rural areas, making visits difficult and phone calls expensive.

Juvenile Justice

The first institution for juvenile delinquency was the New York City House of Refuge established in 1825. Massachusetts followed suit with a facility for boys established in 1847 and one for girls in 1854.

Which of the following is a characteristic of the criminal justice system in the United States?

The incarceration rate of the United States is second only to that of Russia.

The problem with sentencing for cocaine vs. crack possession was that

a majority of crack offenders were African American.

The late 1990s showed an increase in juveniles being arrested for

drug possession.

Mental Health and Substance Abuse Funding

he Substance Abuse and Mental Health Services Administration (SAMHSA) of the Department of Health and Human Services oversees the federal alcohol, drug abuse, and mental health block grants. Since 1981, all mental health expenditures have been in block grants to states. By using a block grant strategy, the federal government removed the power from federal agencies and transferred it to the individual states. Since the creation of mental health block grants, federal funding for mental health and substance abuse services has decreased to $3.4 billion for 2013, $142 million less than for 2012 It is important to recognize how funding has shifted during the past two decades: Although private funding for mental health services had diminished, state and local funding has imploded, leaving Medicaid and Medicare primary sources of revenues. Substance abuse services, on the other hand, continue to rely heavily on state and local revenues (see

The Supreme Court has declared that

it is illegal to execute the mentally retarded

Cesare Beccaria applied all of the following philosophies to corrections in the early history of the United States, EXCEPT

rehabilitation of criminals is key to preventing recidivism.

The "new penology" refers to

the efficient management of high-risk offenders. the new penology eschewed these for the efficient management of large populations of high-risk offenders.

The Community Mental Health Centers Acts

the first Community Mental Health Centers (CMHC) Act was passed by Congress and signed by President Kennedy on October 31, 1963. The enactment of CMHC legislation was not, however, without obstacles. To allay the American Medical Association's fears that the act represented socialized medicine, the CMHC Act of 1963 appropriated funds only for construction purposes. It was not until 1965, when the AMA was reeling from governmental proposals to institute federal health care programs for the aged and the poor, that funds were authorized for staffing CMHCs. Advocates of the CMHC Acts of 1963 and 1965 maintained that a constant target of the legislation was "to eliminate, within the next generation, the state mental hospital, as it then existed."