Category Archives: Human Services

The Mental Health Workforce: A Primer

Source: Elayne J. Heisler, Congressional Research Service, CRS Report, R43255, April 20, 2018

Congress has held hearings and some Members have introduced legislation addressing the interrelated topics of the quality of mental health care, access to mental health care, and the cost of mental health care. The mental health workforce is a key component of each of these topics. The quality of mental health care depends partially on the skills of the people providing the care. Access to mental health care relies on, among other things, the number of appropriately skilled providers available to provide care. The cost of mental health care depends in part on the wages of the people providing care. Thus an understanding of the mental health workforce may be helpful in crafting policy and conducting oversight. This report aims to provide such an understanding as a foundation for further discussion of mental health policy.

No consensus exists on which provider types make up the mental health workforce. This report focuses on the five provider types identified by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) as mental health providers: clinical social workers, clinical psychologists, marriage and family therapists, psychiatrists, and advanced practice psychiatric nurses. The HRSA definition of the mental health workforce is limited to highly trained (e.g., graduate degree) professionals; however, this workforce may be defined more broadly elsewhere. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) definition of the mental health workforce includes mental health counselors and paraprofessionals (e.g., case managers).

An understanding of typical licensure requirements and scopes of practice may help policymakers determine how to focus policy initiatives aimed at increasing the quality of the mental health workforce. Most of the regulation of the mental health workforce occurs at the state level because states are responsible for licensing providers and defining their scope of practice. Although state licensure requirements vary widely across provider types, the scopes of practice converge into provider types that generally can prescribe medication (psychiatrists and advanced practice psychiatric nurses) and provider types that generally cannot prescribe medication (clinical psychologists, clinical social workers, and marriage and family therapists). The mental health provider types can all provide psychosocial interventions (e.g., talk therapy). Administration and interpretation of psychological tests is generally the province of clinical psychologists. …..

Amazon Gets Tax Breaks While its Employees Rely on Food Stamps, New Data Shows

Source: Claire Brown, The Intercept, April 19, 2018

Later this year, Amazon will begin accepting grocery orders from customers using the Supplemental Nutrition Assistance Program, the federal anti-poverty program formerly known as food stamps. As the nation’s largest e-commerce grocer, Amazon stands to profit more than any other retailer when the $70 billion program goes online after an initial eight-state pilot. But this new revenue will effectively function as a double subsidy for the company: In Arizona, new data suggests that one in three of the company’s own employees depend on SNAP to put food on the table. In Pennsylvania and Ohio, the figure appears to be around one in 10. Overall, of five states that responded to a public records request for a list of their top employers of SNAP recipients, Amazon cracked the top 20 in four.

How Far Do SNAP Benefits Fall Short of Covering the Cost of a Meal?

Source: Elaine Waxman, Craig Gundersen, Megan Thompson, Urban Institute, February 22, 2018

From the abstract:
The Supplemental Nutrition Assistance Program (SNAP) aims to reduce hunger and food insecurity by supplementing the purchasing power of low-income families. This analysis explores the adequacy of SNAP benefits by comparing the maximum SNAP benefit per meal with the average cost of a low-cost meal in the U.S., adjusting for geographic variations in food prices across counties in the 48 contiguous states and Washington, DC. We find that average cost of a low-income meal is $2.36, 27 percent higher than the SNAP maximum benefit per meal of $1.86, which takes into account the maximum benefit available to households of varying sizes. The SNAP per meal benefit does not cover the cost of a low-income meal in 99 percent of US continental counties and the District of Columbia.

Related:
Interactive map showing this data at the county level

State of the Union

Source: Stanford Center on Poverty and Inequality, Pathways, Special Issue, 2018

From the summary:
The Stanford Center on Poverty and Inequality is pleased to present its fifth annual report examining the state of the union. In this year’s report, we provide a comprehensive assessment of gender inequality in eleven domains ranging from education to health, employment, earnings, poverty, sexual harassment, networks, and more. The report concludes with a discussion of the most promising sciencebased policies for reducing gender inequality at home and in the labor market.

Articles include:
Gender Identification
Aliya Saperstein
The traditional gender binary just doesn’t work. When respondents of a national survey were asked about their femininity and masculinity, 7 percent considered themselves equally feminine and masculine, and another 4 percent responded in ways that did not “match” their sex at birth (i.e., females who saw themselves as more masculine than feminine, or males who saw themselves as more feminine than masculine).

Education
Erin M. Fahle and Sean F. Reardon
Despite common beliefs to the contrary, male students do not consistently outperform female students in mathematics. It’s only in high school that the male advantage in mathematics surfaces. What’s going on?

Health
Mark Duggan and Valerie Scimeca
For women and men alike, life expectancy has stagnated for the last several years, primarily due to increases in drug poisoning deaths and in the suicide rate. The male-female life expectancy gap, which favors females, fell from 7.6 years in 1970 to 4.8 years in 2010, a reduction of more than one-third.

Employment
Melissa S. Kearney and Katharine G. Abraham
After rising steadily for many decades, the overall female employment rate has been falling since 2000. Why has it fallen? Are there straightforward policy fixes that could increase women’s employment?

Earnings
Emmanuel Saez
When gender differences in labor force participation, fringe benefits, and self-employment income are taken into account, women earn only 57 cents for each dollar earned by men.

Poverty
H. Luke Shaefer, Marybeth Mattingly, and Kathryn Edin
Are women more likely than men to be in deep poverty, official poverty, and near poverty? Yes, yes, and yes.

Safety Net
Linda M. Burton, Marybeth Mattingly, Juan Pedroza, and Whitney Welsh
Why do women use safety net programs more than men? A hint: It’s not just because they’re more likely to be eligible for them.

Occupational Segregation
Kim A. Weeden, Mary Newhart, and Dafna Gelbgiser
Nearly half of the women in the labor force would have to move to a different occupation to eliminate all occupational segregation by gender. This is a classic case of stalled change: If recent rates of change are extrapolated, it would take 330 years to reach full integration.

Discrimination
David S. Pedulla
A new science of gender discrimination is being built with audit studies and other experiments. A key result: Gender discrimination is more likely to emerge when the applicant’s commitment to work can be called into question or when an applicant is behaving in a gender-nonconforming way.

Workplace Sexual Harassment
Amy Blackstone, Heather McLaughlin, and Christopher Uggen
The workplace is rife with sexual harassment. By age 25 to 26, one in three women and one in seven men experience behavior at work that they define as sexual harassment.

Social Networks
Adina D. Sterling
Although men used to have more social ties than men, now the gender gap has reversed and women have the larger networks. But women still have fewer coworker ties than men … and coworker ties matter a lot.

Policy
Marianne Cooper and Shelley J. Correll
What are the most promising science-based policies for reducing gender inequality at home and in the labor market?

Inequality and Competition in State Redistributive Systems: Evidence From Welfare and Health

Source: NakHyeok Choi, Milena I. Neshkova, The American Review of Public Administration, OnlineFirst, Published March 5, 2018
(subscription required)

From the abstract:
When determining their redistributive budgets, states must strike a subtle balance—to provide for their needy residents without becoming a “welfare magnet” and attracting poor individuals from neighboring states. We examine the competing incentives that state politicians face in federal systems and their effects on program accessibility and redistributive spending across U.S. states between 2005 and 2011. Comparing two redistributive programs under state control—Medicaid and Temporary Assistance for Needy Families (TANF)—we find strong evidence of interstate competition in the case of cash assistance programs, but less evidence in the case of health care. Yet our data show that states do not alter their policies in response to rising inequality, that is, when the median voter becomes poorer than the average voter. Moreover, the Great Recession had a greater impact on TANF than Medicaid. We attribute these differential effects to different funding mechanisms used by the federal government to finance the two state-administered programs.

The Relationship between Union Membership and Net Fiscal Impact

Source: Aaron Sojourner, José Pacas, IZA – Institute of Labor Economics, IZA DP No. 11310, January 2018

This paper develops the first evidence on how individuals’ union membership status affects their net fiscal impact, the difference between taxes they pay and cost of public benefits they receive, enriching our understanding of how labor relations interacts with public economics. Current Population Survey data between 1994 and 2015 in pooled crosssections and individual first-difference models yield evidence that union membership has a positive net fiscal impact through the worker-level channels studied.

The High-Tech Poorhouse: An Interview with Virginia Eubanks

Source: Sam Adler-Bell, Jacobin, January 29, 2018

When algorithms are introduced into public assistance programs, the effects are rarely good for poor and working-class beneficiaries. ….

…. Virginia Eubanks, associate professor of political science at the University at Albany, SUNY, has spent the past several years exploring how automation has played out in the American welfare system. Her new book, Automating Inequality: How High-Tech Tools Profile, Police, and Punish the Poor, investigates three experiments in which algorithms are replacing or augmenting human decision-making in public assistance: Indiana’s automated Medicaid eligibility process; Los Angeles’s coordinated entry system for the homeless; and Allegheny County, Pennsylvania’s predictive algorithm for assessing childhood risk of abuse and neglect. …..

SNAP Is Linked with Improved Nutritional Outcomes and Lower Health Care Costs

Source: Steven Carlson and Brynne Keith-Jennings, Center on Budget and Policy Priorities, January 17, 2018

From the summary:
New and emerging research links the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), the nation’s most important anti-hunger program, with improved health outcomes and lower health care costs. This research adds to previous work showing SNAP’s powerful capacity to help families buy adequate food, reduce poverty, and help stabilize the economy during recessions…..