- While most mothers in the COS sample rated their children as being in very good or excellent health, in one site the welfare-to-work programs resulted in a decrease in this rating.
In the area of health and safety, mothers were asked to rate their focal child's overall health by answering the question: "Would you say that your child's health in general is excellent, very good, good, fair, or poor?" For each of the six COS programs, two outcome measures were developed from the responses. In addition, a third outcome measure concerned whether the focal child had had a serious accident, injury, or poisoning. Between 77 percent (Atlanta) and 82 percent (Riverside) of control group mothers in the COS sample reported that their focal child was in very good or excellent health; between 13 percent (Atlanta) and 24 percent (Grand Rapids) reported that their focal child had had a serious accident, injury, or poisoning since study entry.
Two of the six programs — Riverside LFA and HCD — had impacts in this area. In both of these programs, the found impacts, which were based on the mother's health rating, were unfavorable: Mothers' average rating of the general health of their focal child decreased slightly, and a smaller proportion of children were reported by mothers to be in very good or excellent health. (See Table 4.) Specifically, as a result of the Riverside LFA and HCD programs, mean health ratings (on a scale of 1 to 5 points) decreased by .23 and .20 points, respectively; the proportion of focal children rated as in very good or excellent health decreased by about 12 and 10 percentage points and the proportion rated as in fair or poor health increased by 5 and 4 percentage points, respectively.
It should be noted that the primary measure here was one of global health and not specific health problems. In addition, the health assessments were made by mothers, and not by impartial doctors or through a review of health records. While it is entirely possible that the Riverside programs truly changed children's health status, it is also possible that these findings reflect changes in mothers' perceptions of their children's health. As discussed earlier, the Riverside LFA and HCD programs produced large increases in the likelihood that COS mothers would be employed at some point during the two-year follow-up period; their two-year employment rates, relative to control groups', increased by 65 percent in the Riverside LFA program and by 45 percent in the Riverside HCD program. The next largest increase in two-year employment rates was a 15 percent increase, achieved in the Grand Rapids LFA COS sample. It is possible that mothers in the Riverside LFA and HCD COS samples, given their much greater likelihood of employment, perceived their focal children as being in poorer health than mothers in the control groups. For these mothers, even relatively minor focal child health problems (e.g., ear infections) could have caused disruptions in their daily lives, because they would have needed to either stay home from work to care for the child or perhaps quickly make alternative, non-group child care arrangements so they could go to their jobs. Among control group mothers, who were much less likely to be employed, these same relatively minor health problems might not have been as disruptive and thus memorable.
- For all children across the evaluation sites, impacts on the likelihood of events suggesting other child health or safety issues were not common.
Children's health and safety was measured by asking parents if any of their children (1) had been removed from their care or (2) had had a serious accident, injury, or poisoning. Among all control group parents in the seven sites, a surprisingly high proportion — up to 8 percent in a site — reported that a child had been removed from their care during the two-year follow-up period because they could not care for or handle the child.(23) (See the upper panel of Table D.1.) Between 18 and 37 percent of all control group members reported that during the previous two years at least one of their children had had an accident, injury, or poisoning requiring a visit to a hospital emergency room or clinic. Among control group parents with all school-age children, these statistics were similar. (See Table 5.) When all families are considered, one of the 11 studied programs (Columbus Traditional) had an impact on children's being removed from their mother's care (an increase in the incidence of this event) and no programs affected the likelihood of children having an accident, injury, or poisoning that required immediate medical attention. (See the lower panel of Table D.1.) When only families with all school-age children are considered, two programs — Columbus Traditional and Grand Rapids HCD — increased the incidence of children being removed from their home and no programs had an impact on the latter outcome. (See Table 6.)