Final Synthesis Report of Findings from ASPE "Leavers" Grants

Chapter VII:
Child Well-Being and Child Care

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Contents

1. Child Health and Insurance Coverage
2. Children’s Behavior
3. Interactions with Child Welfare Services and Children Living Elsewhere
4. Child Care
5. Chapter Summary 

Endnotes

Since changes in welfare primarily affect families with children, there is concern over how the children of families leaving welfare are faring. Unfortunately, leaver studies contain limited information about children’s outcomes and well-being. Some studies do include information on children’s health status and insurance coverage, school or non-school behaviors, and involvement with the child welfare system. Since few studies report findings for any specific measure, it is difficult to make cross-study comparisons. However, from these limited results we can begin to assess the range of outcomes for children in families that have left the TANF program. 

A. Child Health and Insurance Coverage

One set of measures of child well-being center on child health and health insurance coverage. Ten of the studies with survey data report the percentage of children without any type of health insurance coverage (Table VII.1). This number ranges from less than 10 percent in Missouri, Massachusetts, and the Bay Area, to over 20 percent in Arizona and Illinois. Not surprisingly, some of the states with low percentages of uninsured children, like Massachusetts, are also the states with the highest rates of Medicaid coverage. However, Missouri and the Bay Area also have low percentages of uninsured children but only moderate rates of Medicaid coverage. Higher than average private insurance coverage among children of leavers in these two studies accounts for this discrepancy.

Table VII.1:
Measures of Child Health and Uninsurance for Single-Parent Leaver Families' Children

Measure	AZ	DC1	GA	IL1	IA	MO	MA1	SC1,2	WA	Bay Area
Health Insurance3
Uninsured	26	16	11	29	20 4	8	8	10	13	9
Medicaid	51	60	83	53	62	68	83	85	67	64
Employer	12	12	5	23 5	11	20	10	7	9
Other	8	11	4		18	3		4	10	28 6
Child health
Excellent			64				50	42
Very good			14				24	25
Good			13				18	24
Fair			4		6 7		6	8
Poor			1				1	1
Child's health better/worse since exit								39/3
Child lacks access to routine health care								7
1Results are for all cases, not just single-parents. 2Results are for families that remain off of welfare at the time of the survey. 3Numbers may not sum to 100% because multiple coverage is possible. 4In 20 percent of families, none of the children are covered. In 40 percent of families, children are uninsured at some point over the year. 5Includes all private coverage. 6Includes all private or other government insurance. 7Iowa reports child's health is fair or poor combined. Source: See Appendix B for a complete listing of the leavers studies referenced.

 Child health is also a measure of child well-being. In the four states reporting child health, the percentage of leaver families with children in poor or fair health as reported by the parent in response to the grantee survey is relatively low, ranging from 5 to 9 percent. Only South Carolina shows how child health changes between the time families receive TANF and after they exit. This study reports that 39 percent of leaver families say their child is in better health since exit, compared with only 3 percent who feel their child is in worse health. South Carolina also reports results for children’s access to health care. The study reports that 7 percent of leaver families have a child that lacks access to routine health care since TANF exit.

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 B. Children’s Behavior

Another way to assess child well-being is to examine indicators of a child’s behavior. Some of the ASPE-funded leaver studies directly ask about current behavior relative to pre-exit behavior (e.g. is child behavior better or worse now?). Washington state asks about behavior for the post-exit period and the pre-exit period separately. Overall, these limited results suggest that child behaviors have not, on average, worsened for families since their exit from TANF.

 Four studies report some results for children’s school-related behavior (Table VII.2). When asked whether a child’s school-related behavior was better or worse since exit, the majority of leavers said ‘better’ with a only small number reporting ‘worse’. For example, in South Carolina, 60 percent of families said their child had a greater concern for doing well in school since exit, while only 8 percent said that concern had decreased. In Iowa, 43 percent of families report school behavior and performance was better relative to exit, and only 8 percent reported it was worse.

Table VII.2:
Measures of School and Non-school Related Behaviors of Single-Parent Leaver Families' Children

Measure	GA	IA	MA1	SC1,2,3	WA 2	Bay Area
School-Related Behaviors
High level of school engagement		45
Child's homework better/worse since exit				60/10
Child's concern for doing well in school is more/less since exit				60/8
Child's school performance very good/not good at all				43/4
School behavior and performance better relative to exit		43
School performance better than others same age			45 4
Suspension or expulsion from school		29	13		19(24) 5
Dropped out of school					6(5) 5
Non-School Related Behaviors
In trouble with law				5(4)	15 (15)
Child ran away from home for overnight					6 (10)
Child engages in risk behaviors						12
Child ages 5-13 unsupervised some hours per week						8
Often/sometimes doesn't get along with others	31
Often/sometimes unable to concentrate	33
Often/sometimes unhappy, sad, or depressed	26
Child's behavior better/worse since exit				44/11 6
Behavior compared to others of same age - better			42 4
1Results are for all cases, not just single-parents. 2Numbers in parentheses are for before exit for SC and caseload for WA. 3Results are for a focal child in family. All reports are out of families with school-age children. Results are for families that remain off of welfare at the time of the survey. 4Information available for categories much better, little better, about the same, little worse, much worse. 5Asked of leavers with children ages 11 or older. 6SC has many other measures of changes in behavior relative to exit including how child gets along with others, whether more/less outgoing, and temperment. Source: See Appendix B for a complete listing of the leavers studies referenced.

Another important school-based outcome for children is whether they have been suspended or expelled from school. The percentage of TANF leavers that had children suspended or expelled from school ranges from 13 percent in Massachusetts to 29 percent in Iowa. Washington reports that the share of leaver children (age 11 or older) expelled or suspended is 19 percent—lower than the share of current welfare recipient children expelled or suspended in that state, 24 percent. 

Several studies report other non-school-related child behaviors. These range from children being in trouble with the law to broad behavioral/emotional measures, such as how often a child reports being unhappy or depressed. Two studies report the share of families with children who had been in trouble with the law — 5 percent in South Carolina and 15 percent in Washington. Both of these studies report similar findings for families receiving TANF. The Bay Area study reports that 12 percent of children engage in risky behaviors and 8 percent of 5 to 13 year olds are unsupervised for some hours during the week. ⁴⁵ 

Georgia reports that about a third of leaver children often or sometimes have trouble getting along with others, are unable to concentrate, or are unhappy, sad, or depressed. South Carolina leavers’ report that their children’s behavior is better since exit in 44 percent of families and is worse in 11 percent. Finally, Massachusetts asks leavers to compare their children’s behavior with that of other similarly aged children and finds that 42 percent consider their children to be more well-behaved than other children. 

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C. Interactions with Child Welfare Services and Children Living Elsewhere

 Another way to assess the well-being of children is through their interactions with child welfare service agencies. Five studies report varying types of child welfare interactions and services, each of which are reported separately here (Table VII.3). Arizona, Illinois, Missouri, and Washington report interventions by child protective services, either out-of-home placements or substantiated abuse/neglect reports. The share of families involved with the child welfare system is relatively small in Arizona, Illinois, and Washington, from less than 1 percent to 2 percent. Missouri reports a higher rate (6 percent) of substantiated abuse/neglect reports.

Table VII.3:
Measures of Child Welfare Services and Other Outcomes for Single-Parent Leaver Families' Children

Measure	AZ 1	DC 1,2	GA	IL 1,2	IA	MA2	MO2	SC 1,2,3	WA 1
Child protective services	0.4(0.6)
Out-of-home placements	0.1(0.2)			0.2(0.4)4					0.6(1)
Substantiated abuse/neglect				0.7(1)4			6		2(4)
Foster care services					7(7)
Child welfare services					13		2
Family preservation services					1(2)		2
Child sent to live with someone else	8(9)	5(6)		8(9)				5(5)	19(18) 5
Absent parent visits
Deceased			37 6			3 7
Never			25			34
Once/several times a year			14			12
One to three times a month			10			11
Once a week			5			8
Several times a week or more			10			31
1Numbers in parentheses are pre-exit for leavers for AZ, DC, and IL. Numbers in parantheses are for caseload in WA. 2Results are for all cases, not just single-parents. 3Results are for families that remain off of welfare at the time of the survey. 4Figures from administrative data in 2nd quarter after exit. 5Includes child in foster care, child sent to live with relatives, child lives with father. 6Includes leaver reports that father is dead or "like dead." Absent parent visit frequency asked of the 97% of children not living with their father. 7All leaver families regardless of whether both parents live in household were asked this question. Source: See Appendix B for a complete listing of the leavers studies referenced.

Arizona, Illinois, and Washington report lower rates of these child welfare agency interactions after exit than before, but the numbers are so small that the differences may not be statistically significant. Finally, Iowa reports a higher rate of child welfare services use than other studies, 13 percent, but this includes interactions with foster care services (7 percent) as well as family preservation services (1 percent). These percentages are similar for the time period while families are receiving TANF.

 Another measure of child well-being focuses on whether children were displaced out of their homes due to financial problems. The percentage of leaver families where children were forced to live elsewhere ranges from 5 percent in DC to 19 percent in Washington. Note, however, that the percentage for Washington includes children entering foster care. The share of leavers experiencing this outcome is not much different after exit than before exit.

Interactions with Absent Parents. An additional concern for children in single-parent families is connection with an absent parent. Two studies report the frequency of visits from other parents — Georgia, which asks about absent fathers, and Massachusetts, which asks about the “other biological parent.” Over a third of those asked this question in Massachusetts report the absent/other parent is either deceased or never visits (Table VII.3). In Georgia, 37 percent of absent fathers were either dead or defined as “like dead” and another 25 percent never visited, for a total of 62 percent with little or no contact. In Georgia, 15 percent of absent fathers visit once a week or more compared with 39 percent in Massachusetts.⁴⁶

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D. Child Care

Since the transition from welfare to work is a major goal of many states’ welfare programs, the need for child care among TANF leavers is an important consideration. Child care subsidies are generally available to employed TANF leavers, depending on their income level. Actual receipt of these subsidies is influenced by the type of care arrangement leavers use, their knowledge about and eligibility for subsidies, and the ease with which subsidies can be accessed. Concerns about the quality of care given to children of working TANF leavers are also important, although unfortunately measures of child care quality are generally beyond the scope of the surveys conducted. ⁴⁷

Results for eight studies are shown in Table VII.4. Four of these studies report results for employed leavers and four report results for all leavers.⁴⁸ Most studies report results by age of child, as the child care needs of school aged children differ from those of younger children.

Table VII.4:
Child Care Arrangements of Employed Single-Parent Leavers: Survey Data

Type of Care	IL1,2		MO		IA2	WA1
	<6	6-12	<6	6-13	<13	<13
Employed Leavers
Uses non-parental child care	93	90	75	40	78	82
Type of Arrangement for those using child care
Relatives/ Siblings	58	59	41	42	65	41
Friends/ Neighbors	9	12	13	11	6
Center/ Afterschool care/ Church or club	12	8	26	36 4	14	23
Preschool/ Head Start	2		3		4
Family Day Care/ Babysitter In-home	15	16	18	8	35	13
Other	5	5			1	24 5
Type of Care	AZ2		SC6		GA	Bay Area
	<6	6-12	<6	6-12	<12	<13
All Leavers
Uses non-parental child care	53	35	62	26
Type of Arrangement for those using child care
Relatives/ Siblings	57 3	43 3	42	29	25	54
Friends/ Neighbors				13	3
Center/ Afterschool care/ Church or club	25	30	44	50 4		30
Preschool/ Head Start	11	23 7	2		47	3
Family Day Care/ Babysitter In-home	8	4	6	7	47
Other				2	4 8
1Study reports of type of arrangement are recalculated to reflect percentage of families using non-parental child care. 2State reports results for leavers in work, job search, education, or training. Illinois reports results for all leavers, not just single-parents. 3Includes friends and relatives. 4Includes school sponsored programs. 5Other includes mutliple arrangements, preschool/Head Start, child self-care, employer-sponsored care and unspecified care. 6Results are for families that remain off of welfare at the time of the survey. Results are reported for "pre school" and "school age" children. 7Includes school. 8Represents child stays alone. Source: See Appendix B for a complete listing of the leavers studies referenced.

Child Care Arrangements. A substantial percentage of families do not have a child care arrangement, other than parent care or regular schooling. The percentage of leaver families with children under age 6 using non-parental child care ranges from 53 percent in Arizona (among all leavers) to 93 percent in Illinois (among employed leavers). The percentage with school-age children using non-parental child care is generally lower. Arizona, Missouri, and South Carolina report that 35, 40, and 26 percent of older children, respectively, have a non-parental child care arrangement.⁴⁹ Illinois has by far the largest percentage of leavers with children ages 6 to 12 using a non-parental arrangement, 90 percent.

 Differences in the use of non-parental care across studies are, in part, due to the different categorizations of care used in each study. While most states directly ask about use of non-parental care, Illinois asked all families who were working, in training, education, or job search activities how they cared for their children. Families who responded “no one” or “spouse/partner” are categorized in this report as non-parental care. Georgia asked all families with children under age 12 about child care arrangements; however, their results do not allow us to separately report use of non-parental care. The Bay Area study asked all families with children under 14 if they used a non-parental care arrangement, but did not report the percentage that was only using parental care.

There are a number of similarities in the types of non-parental care used.⁵⁰ In all of the studies except Georgia and South Carolina, relatives and siblings are by far the most common source of care for pre-school and school age children. The rate of relative/sibling care reported in these studies ranges from 41 percent for pre-schoolers in Missouri to 65 percent for all children under fourteen in Iowa. Leavers in South Carolina are equally likely to use relative/sibling care and center-based care for pre-school children (about 40 percent each). However, for school age children, the share of families using relative/sibling care in South Carolina drops to 29 percent. This latter figure may be among the lowest across the studies because it is the only study to include all school age children, even those older than 13 or 14. Georgia reports the lowest rate of relative/sibling care at 25 percent, despite including parental care in this category. In fact, all of Georgia’s child care numbers are very different from the other studies.⁵¹

The next two most common types of child care arrangements after relative/sibling care are center based care (including after school care, churches, and clubs mainly relevant for older children) and family day care/babysitter care in the home. Arizona, Missouri, Washington, and the Bay Area find center care to be the second most common type of arrangement, while Illinois and Iowa find greater use of family day care/babysitters.

   Paying for Child Care. Paying for child care is a critical issue for families leaving TANF for employment. Costs of child care and child care subsidies can affect, and often determine, the choice of arrangements. Three studies report the percentage of employed leavers with child care arrangements who reported paying for child care. Three additional studies report such percentages for all leavers. The percentage of families paying for child care for at least one child varies from 23 percent of all leavers in the Bay Area study to 61 percent of employed leavers in Massachusetts and South Carolina (see Table VII.5). Illinois and Missouri report that the percentage of families paying for child care varies with the age of the child, although the two patterns are not consistent across these studies.

Table VII.5:
Single-Parent Leavers Paying for Child Care: Survey Data

State/ Study	Percent of Leavers with Childcare Arrangements Paying for Care	Percent of Leavers Using Subsidies	Average Monthly Costs for Families Making Payments
Employed Leavers
District of Columbia1		5/3 2
Illinois 1,3	44	17	$211
Iowa 3	55	17	$244
Massachusetts1	61	43	$165
Missouri1	40	14/36 4	$277
Children <5	38		$221
Children 6-13	46		$171
South Carolina1,5	61	26
All Leavers
Arizona		15 6
Washington		20
Bay Area	23	24 7
1Results are for all cases, not just single-parents. 2Percent of employed leavers receiving assistance from welfare office is 5%; receiving assistance from other private sources is 3%. 3Percentage includes those working as well as those in job search, education, or training. 436% have used subsidies at some point since exit. 5Results are for families that remain off of welfare at the time of the survey. 6Percentage is from administrative data for 1st quarter after exit. 7Percent receiving government subsidized child care at exit. Source: See Appendix B for a complete listing of the leavers studies referenced.

Another issue related to cost of child care for working leavers is their use of government child care subsidies. Six studies report use of subsidies by employed leavers and three studies report use among all leavers. The range in the percentage of families using this type of assistance varies from about 5 percent in DC to 43 percent in Massachusetts. Most studies find 15 to 25 percent of employed leavers are using child care subsidies. The studies examining all leavers find similar results. One potential explanation for this low utilization is that many families do not have a non-parental child care arrangement, and generally less than half of families who have an arrangement pay their providers for care. However, it is also possible that some leavers either do not know they could obtain these subsidies, are ineligible for subsidies, or that the subsidies are difficult to use.

Finally, four studies report the average monthly costs for child care among families paying for care. The average monthly out-of-pocket cost ranges from $165 in Massachusetts to $277 in Missouri. Missouri also reports on cost by age of child, showing that costs for young children (under age 5) are lower than for older children (ages 6 to 13), $221 compared to $171. These cost data do not distinguish between those paying the full cost of care and those making co-payments for subsidized care.

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E. Chapter Summary

The ASPE-funded leaver studies include a number of different measures of child well-being. These include measures of health insurance coverage and health, school and other behavior, interaction with child welfare services, and contact with absent parents. One-tenth to one-quarter of leaver families have uninsured children, although reports of children in poor or fair health are generally low, ranging from 5 to 10 percent. While the measures of child behavior are varied, most studies that compare behaviors pre- and post-exit find that the majority of leavers report child behavior is better after exit. Rates of interaction with child welfare services range from 1 to 13 percent, including reports of abuse/neglect and foster care services. There is little evidence on whether the percentage of families involved in child welfare services changed after exiting TANF.

 The studies also report on the use of child care, types of arrangements, and use of government subsidies. The findings show that a substantial percentage of leaver families rely on parental care. For those using non-parental care, relatives and siblings of the child are by far the most common sources of care for children. The studies also report that many families are not paying for care (i.e. using unpaid modes of care), and about 15 to 25 percent use government child care subsidies.

 Endnotes

⁴⁵Risk behaviors include being suspended, expelled, dropping out of school, getting in trouble with the police, having a drug or alcohol problem, doing something illegal to get money, or getting pregnant or getting someone else pregnant.
⁴⁶Massachusetts includes all children, even those living with both biological parents, in reported figures. Therefore, the 39 percent of children with frequent visits includes some percent of children living with both parents. This percentage is not reported, but in roughly 20 percent of leaver households, there is a spouse/parent present.
⁴⁷South Carolina, Illinois, and Iowa include some information about child care quality and parental satisfaction with child care arrangements.
⁴⁸The District of Columbia and Massachusetts also report child care arrangements used by employed leavers, but the categories of care reported make it difficult to compare these studies to the others. Their findings are excluded from this discussion.
⁴⁹South Carolina's percentage may be lower because it asks about all school-age children, while Arizona and Missouri restrict their findings to children ages 6 to 12.
⁵⁰To facilitate comparisons across studies, we computed the share of children in each type of care arrangement out of all children in non-parental care.
⁵¹The high percentage of families using Head Start centers in Georgia may be a combination of families using Head Start or other center-based care.

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