ABOUT US

Finding Common Ground (FCG) is a collaborative effort between researchers at Columbia University's Mailman School of Public Health and Boston Medical Center. The project is dedicated to developing a public health agenda that integrates the healthcare needs and rights of women and children, and to reframing public discourse so that advocacy for one is seen to benefit both. Most recently, Finding Common Ground in the Era of Welfare Reform has been examining these issues in the context of the dramatic policy shifts that comprise "welfare reform." Despite various evaluations of welfare reform currently underway by others, this project is the only one to focus on the consequences for women's reproductive and child health. The importance of the PRWORA to the social well-being of millions of American families makes such evaluation necessary despite its complexity.

Top

 

Project overview

Welfare Reform

The welfare reform law of 1996 mandated work requirements and lifetime time limits on income assistance for poor families with children, administratively separated Medicaid from TANF, and "devolved" considerable autonomy to the states to shape their own policies and programs. While the states were constrained by the broad parameters of the federal legislation (ceilings such as 5-year lifetime limits and work requirements after 2 years), they were free to further restrict benefits and to impose behavioral requirements on recipients through reductions or termination of benefits. Consequently, there are now more than 50 state and county versions of welfare reform.

Our Approach

Since 1997, the Finding Common Ground project has focused on assessing whether federal and state welfare reform policies have had an impact on the health and well-being of poor women and children. In particular, we have paid attention to the state policy choices related to reproductive and maternal behaviors, such as requiring childhood immunizations, pediatric medical visits, family planning counseling, and family caps. Toward this end, we have taken a multipronged research approach, including assembling a multidisciplinary Advisory Committee; conducting two national surveys of state agencies Child Protective Services (CPS) and Maternal and Child Health (MCH) that interact with TANF and are important players in the health arena for women and children; delineating reproductive and infant health indicators that might be sensitive to welfare policies, and potential data sources to assess this impact; analyzing the relation between changes in cash assistance, Medicaid and uninsurance; and conducting in-depth state case studies to further examine the impact of states' welfare policy choices on health, and to establish collaborative arrangements for data collection and analysis at the state level. The timing of this undertaking is critical with the welfare reform law due for reauthorization in 2002.

Top

 

Advisory Committee

The FCG Advisory Committee comprises experts from various disciplines within the fields of health and social policy. Drawn from the local, state and national levels, the committee provides a comprehensive perspective that continually informs our research and activities.

Hani Atrash, MD, MPH
Chief, Pregnancy and Infant Health Branch
Division of Reproductive Health
Centers for Disease Control and Prevention

Deborah Bell
Executive Director of Professional Staff Congress
The City University of New York

Paula Braverman, MD, MPH
Professor of Family and Community Medicine
University of California at San Francisco

Vicki Breitbart, EdD
Associate Vice President
Clinical Services
Planned Parenthood of New York City

Martha Davis, JD
Legal Director
NOW Legal Defense and Education Fund

Sally Fogerty, BSN, MEd
Assistant Commissioner
Massachusetts Department of Public Health

Fernando A. Guerra, MD, MPH
Director of Health
San Antonio Metropolitan District

Grant Higginson, MD, MPH
State Health Officer
Oregon Health Division

Deborah Klein Walker, EdD
Associate Commissioner
Massachusetts Department of Public Health

Jodie Levin-Epstein
Senior Policy Analyst
Center for Law and Social Policy

Velvet Miller, PhD
My Parents Concierge, Trenton NJ
Broker service for adult children and their elder relatives

Mary Murphree, PhD
Regional Administrator
Women's Bureau, Region II
For Identification Purposes Only

Julius Richmond, MD
Professor of Health Policy Emeritus
Harvard Medical School

Allan Rosenfield, MD
Delamar Professor and Dean
Mailman School of Public Health, Columbia University

Benjamin P. Sachs, MD
Chief, Ob-Gyn Department and Professor
Beth Israel Deaconess Medical Center
Harvard Medical School & School of Public Health

Deborah Smith, MD
Assistant Professor, Ob-Gyn
Howard University Hospital

Barry Zuckerman, MD
Chief of Pediatrics
Boston Medical Center

Top

 

Faculty and staff

FCG includes researchers from Columbia University and Boston Medical Center. They represent the fields of public health, obstetrics/gynecology, pediatrics, sociomedical sciences, statistics, and public policy.

Principal Investigators

Wendy Chavkin MD, MPH
Co-Principal Investigator and Professor
wc9@columbia.edu

Wendy Chavkin is the Co-Principal Investigator of the project and is a Professor of Clinical and Public Health and Obstetrics & Gynecology at Columbia University. For over two decades, Dr. Chavkin's research has focused on testing, prevention, perinatal transmission and policy in pregnancies with HIV; policy and treatment in pregnancies with drug abuse; abortion, including policy and medical education; surveillance, planning and assessment of services for maternal and child health.

Dr. Chavkin is Editor of the Journal of the American Medical Women's Association and is an Associate Contributing Editor for Women's Health for the American Journal of Public Health.

Paul Wise, MD, MPH
Co-Principal Investigator and Associate Professor
pwise@bu.edu

Co-Principal Investigator, Paul Wise, is based in the Department of Pediatrics, Boston University School of Medicine, the academic link for child health at Boston Medical Center. At BMC, he is Director of Social and Health Policy Research and Associate Professor of Pediatrics. This department has a national reputation for leadership in research advocacy and clinical service concerned with issues related to poverty and underserved communities.

Staff

Diana Romero, PhD, MA
Project Director
drr6@columbia.edu

Diana Romero serves as the project's director and is an Assistant Professor in the Department of Population and Family Health at Columbia University's Mailman School of Public Health. Her research interests include social policies related to health and poverty, and women's reproductive health issues, particularly among low-income Hispanic and African-American populations. Dr. Romero also is a medical writer with several years experience writing and editing publications on women's health and contraceptive technologies in particular.

Lauren Smith, MD, MPH
Investigator
lauren.smith@bmc.org

Lauren Smith is Medical Director of the Pediatric Inpatient Unit at Boston Medical Center and an Assistant Professor of Pediatrics at the Boston University School of Medicine. She completed her pediatric residency and Chief Residency at Children's Hospital-Boston, and a fellowship in general pediatrics at Boston Medical Center. Dr. Smith's clinical and research activities primarily focus on improving the health of underserved populations. She recently received a Robert Wood Johnson Faculty Development grant.

Liza Camellerie, BA, BS
Project Coordinator
lc2075@columbia.edu

Liza Camellerie serves as Project Coordinator for Finding Common Ground. She has extensive experience in media and communications, having worked on socially oriented programs at MTV and a PBS documentary on women's health care in the United States. While in college, she worked at the National Organization for Women on issues such as Violence Against Women and the Equity in Prescription and Contraceptive Coverage Acts. Ms. Camellerie received Bachelor's degrees in American Studies and Communications.

Julia Jung Choe, BA
Project Coordinator
jjc2004@columbia.edu

Julia Choe is a Masters student in Population and Family Health at Columbia University's Mailman School of Public Health and serves as Project Coordinator for Finding Common Ground. Prior to her graduate study, Ms. Choe conducted extensive sociological and clinical research on the health of San Francisco drug users and women. She has mentored and tutored elementary school aged children in San Francisco, and continues this work with teens in NYC. She plans to continue working in public health as an adolescent health educator.

Barbara Pastrana, MD
Research Assistant
bap2001@columbia.edu

Barbara Pastrana is a graduate student in the Population and Family Health Program at Columbia University's Mailman School of Public Health. Before pursuing her studies in the United States, Dr. Pastrana was the head physician at a rural community clinic in her native Mexico. After completing her Masters degree, she will continue to focus on improving maternal and child health care, both at the patient and community levels.

Top

Key Support

The Finding Common Ground project has received support from a variety of sources, including private foundations and government agencies:

Centers for Disease Control and Prevention

Ford Foundation
Human Development and Reproductive Health Unit

General Service Foundation
Reproductive Health and Rights

Maternal and Child Health Bureau
A cooperative agreement with HRSA through
the Association of Schools of Public Health

Office of Population Affairs

Open Society Institute-NY
Reproductive Rights Program

The Moriah Fund
Population and Reproductive Health

Top

Presentations

The FCG research staff have been presenting study activities and findings to diverse audiences. The multidiciplinary nature of the project requires that the most current information on welfare reform policies and the health of women and children be disseminated to a wide range of advocates, policymakers, health care providers, welfare personnel, and other researchers.

Below is a list of presentations by Finding Common Ground staff. Slide materials from more recent presentations may be available to download if this symbol (+) appears next to the citation.

"Violence, Substance Abuse, and Mental Health Among Poor Women: Relevance Within the Context of Welfare Reform." Trapped by Poverty/Trapped by Abuse Conference, Ann Arbor, Michigan, October 28, 2001.

"Unwoven Tapestries: History of the Women's Health Movement." Health, Law and Human Rights: Exploring the Connections. American Society of Law, Medicine and Ethics (ASLME) Conference. Philadelphia, PA September 29-October 1, 2001.

"State of Welfare Reform Policies, Medicaid Declines, and Increased Uninsurance." Maternal, Infant, and Child Health Epidemiology (MICHEP) Workshop, Atlanta, GA, December 12-13, 2000.

"Welfare Reform and Women's and Children's Health: State Case Studies." Maternal, Infant, and Child Health Epidemiology (MICHEP) Workshop, Atlanta, GA, December 12-13, 2000.

"Welfare Reform Policies and Maternal and Child Health Services: Findings from a National Study." American Public Health Association annual meeting, Boston, MA, November 13, 2000.

"Women's Reproductive Health in a "Reformed" Welfare System." American Public Health Association annual meeting, Boston, MA, November 14, 2000.

"National and State-Level Welfare Reform Developments and the Health of Women and Children." Presentation for staff at the San Antonio Metropolitan Health District, June 2000.

"Benefit Use, Health Status and Household Hardship After Welfare Reform Among Families with Chronically Ill Children." Pediatric Academic Society annual meeting, Ambulatory Pediatric Association, May 2000.

"Monitoring the Impact of Welfare Reform on Women's Health." Association of Maternal and Child Health Programs (AMCHP) annual meeting, March 2000.

"Ending Women's Poverty: A Report from the States." Testimony at Congressional Staff Briefing, Washington, DC, March 2000.

"Sex, Reproduction, and Welfare Reform." Conference entitled "To Promote the General Welfare: Ending Women's Poverty." Hosted by NOW-LDEF and Georgetown University, Washington, DC, March 2000.

"The Implications of Changing Federal Welfare Policy for the Health of Women and Children." CUNY Urban Health Colloquium, NY, NY, March 2000.

"Women's and Children's Health in a 'Reformed' Welfare System: The Paradox of Denying Aid to Mothers while Trying to Safeguard their Children." Work, Welfare and Politics conference, University of Oregon, Eugene, OR, February 2000.

Presentation for NYS Family Planning Advocates annual legislative conference, workshop entitled "Welfare Reform Revisited," Albany, NY, February 2000.

"Tapping TANF for Teen Pregnancy Prevention: A Working Session." Hosted by CLASP and the National Campaign to Prevent Teen Pregnancy, Washington, DC, January 2000.

"Welfare Reform and Women's and Children's Health." Administration for Children and Families (Region VI), conference entitled "Dynamic Partnerships: Strategies for a New Millennium," Dallas, TX, January 2000.

"Welfare Reform Policies and Maternal and Child Health Services: Findings From a National Study," Maternal, Infant and Child Health Epidemiology Workshop. Centers for Disease Control and Prevention, Atlanta, GA, December 1999.

"The Impact of Welfare Reform Policies on Child Protective Services: A National Study," Maternal, Infant and Child Health Epidemiology Workshop. Centers for Disease Control and Prevention, Atlanta, GA, December 1999.

"Welfare Reform and Reproductive Freedom in NYS." Part of a three-part seminar entitled "Exploring the Economics of Reproductive Freedom." Hosted by Urban Justice Center, New York, NY, September-October 1999.

"Exploring the Economics of Reproductive Freedom." Meeting sponsored by the Urban Justice Center, New York, NY. October 13, 1999.

"Health Sector Reform: The US Picture." Annual meeting of the Affinity Group on Population, Reproductive Health and Rights. Annapolis, MD, October 3, 1999.

"Welfare Reform: Chronic Child Illness and Employment Among Welfare Recipients." Pediatric Academic Society annual meeting, Ambulatory Pediatric Association, San Francisco, CA, May 1999.

"Knowledge of Welfare Reform Among Families with Chronically Ill Children." Pediatric Academic Society annual meeting, Ambulatory Pediatric Association, San Francisco, CA, May 1999.

"Child Care After Welfare Reform." Meeting entitled, "Healthy Child Care America: Quality Child Care in the Millennium." Hosted by the Child Care Bureau and Maternal and Child Health Bureau, US Department of Health and Human Resources, Rockville, MD, May 22, 1999.

Invited discussant in health policy seminar on the "Family Health Initiative." Hosted by the Maternal and Child Health Bureau, Health Resources and Services Administration (Peter C. van Dyck). Washington, DC, May 14, 1999.

"Improving Maternal and Pregnancy Outcomes." Healthy People 2000 Progress Review for Maternal and Infant Health. (Live broadcast) US Department of Health and Human Services. Washington, DC, May 5, 1999.

"The Impact of Welfare Reform on Women and Children." School of International and Public Affairs, Columbia University, Women in International and Public Affairs spring policy conference. New York, NY, April 20, 1999.

"The Impact of Welfare Reform Policies on Child Protective Services: A National Study." Taylor Institute/University of Michigan Trapped by Poverty, Trapped by Abuse conference. Ann Arbor, MI, April, 1999.

Invited discussant in meeting on "Changes in the Welfare Law." Hosted by Women's Bureau, US Department of Labor (Mary Murphree) and US Department of Health and Human Services (E. Lower-Basch). New York, NY, March 19, 1999.

"Welfare Reform: How Is It Affecting the Health and Well-Being of Children?" Annual Grantmakers in Health meeting on Health Philanthropy: Social inequalities in Health. Tempe, AZ, February 1999.

"Welfare Reform: How to Measure the Effects of Welfare Reform on MCH." Maternal, Infant and Child Health Epidemiology Workshop. Centers for Disease Control and Prevention, Atlanta, GA, December 1998.

"Finding Common Ground in the Era of Welfare Reform and Medicaid Managed Care," Fall Seminar Series, Center for Population and Family Health, Joseph L. Mailman School of Public Health, Columbia University, September 1998.

Implications of the New National Adoption Legislation for Women in the Context of Welfare Reform," Abandoned Infants Association National Conference, May 1998.

Top

RESEARCH

Overview

Since the passage of the Personal Responsibility Work Opportunity and Reconciliation Act (PRWORA) in 1996, the Finding Common Ground project has focused on investigating the potential impact of federal and state welfare reform policies on the health and well-being of poor women and children. In particular, we have paid attention to the state policy choices related to reproductive and maternal behaviors.

To learn more about each of our projects, please choose from the list on your left.

Top

National surveys

FCG surveyed state directors of Child Protective Services (CPS) to assess the effect of state welfare reform policies on child protective services. We also conducted a survey of state directors of Maternal and Child Health (MCH) services to assess the impact of TANF regulations on policies and programs specifically addressing women's and children's health.

Child Protective Services Survey

This survey, administered via phone inverviews with state directors of Child Protective Services (CPS), sought to document whether changes in state welfare policies have had an impact on child protective services.

Maternal and Child Health Survey

To assess the impact of TANF regulations on policies and programs specifically addressing women's and children's health, we surveyed state directors of Maternal and Child Health (MCH) services. Some of the topic areas explored in the survey include: children's health and child care; maternal and women's health; adolescent health; Medicaid, CHIP and other assistance programs; immigrants and domestic violence.

Top

 

State case studies

To more fully understand the factors contributing to women's and children's health outcomes, Finding Common Ground is conducting in-depth state case studies in select states. Involving both qualitative and quantitative components, these case studies will provide a rich understanding of how specific welfare policies intersect with areas such as health insurance, food assistance, and child care.

Qualitative Research

The qualitative component of the state case studies involves conducting in-depth semistructured interviews with directors of various agencies (e.g., TANF, Medicaid, CPS, Food Stamps, child care) to learn about both the policy perspective and actual implementation procedures. We also interview health care providers, advocacy groups, and safety-net providers (e.g., community-based organizations and advocacy groups). Through interviews with such state policymakers and administrators, we can gain an in-depth understanding of the nature of the interaction among agencies, as well as programmatic issue encountered by welfare clients.

Quantitative Research

The quantitative component, currently in the planning stage, consists of two main parts: secondary data analysis and primary data collection. We are carrying out data linkages with TANF, Medicaid, vital statistics and health outcomes data, to the extent possible, in order to identify any changes in trends since welfare reform was implemented. The second part of the quantitative research protocol consists of primary data collection in pediatric health clinics. Here we will collect information from mothers of chronically ill children to ascertain if they or their children have experienced changes in their health status, or utilization of health services since these policies took effect.

Top

TANF and uninsurance

Based on an analysis of data collected in all 50 states, Finding Common Ground found that certain state TANF policies were associated with increases in uninsurance and declines in Medicaid. Specifically, states with policies to deter people from enrolling in TANF had greater increases in uninsurance and steeper drops in Medicaid enrollment than states without such policies.

Top

Extant Data Set Analyses

To answer the complex questions about the effect of welfare reform policies on women's and children's health, Finding Common Ground will conduct quantitative analyses of extant data sets. Our research questions will focus on the potential impact of TANF policies on: (1) health care access and utilization (including safety-net providers) and (2) health outcomes among women and children.

Specific questions that we seek to address include the following:

1) Access to health services utilization of health services: Has the proportion with health insurance changed in the welfare-eligible population? Has the recent increase in uninsurance resulted in a change in health care utilization by poor women and children? Are specific health services being over- or underutilized since welfare reform too affect?

(2) Health outcomes: What has been the impact on the health of women and children? Has there been an increase or decrease in certain conditions that may be sensitive to changes in health-care utilization, such as preterm delivery, asthma.

Our Approach to These Questions

We will first utilize public-use data, including vital statistics and national surveys (e.g., Surveys of Program Dynamics, National Health Interview Survey, National Hospital Discharge Survey, Pregnancy Risk Assessment Monitoring Survey (PRAMS),); that permit state-based analyses. We will work closely with state and local agencies to identify efficient mechanisms to link these datasets in ways that provide new insights into relationships between welfare and health. Of special interest are linkages between TANF participation and health service utilization data sets, including hospital discharge and Medicaid. Other candidate datasets for linkage include family planning, abortion, child protective services, and other maternal and child health program data.

We think it likely that the assessment of welfare's effects on health will require a series of analyses based on different data sources. These pilot efforts will demonstrate which methods and indicators are most promising for assessing welfare reform's impact on reproductive and infant health indicators.

Top

Clinical surveys

Based on an analysis of data collected in all 50 states, Finding Common Ground found that certain state TANF policies were associated with increases in uninsurance and declines in Medicaid. Specifically, states with policies to deter people from enrolling in TANF had greater increases in uninsurance and steeper drops in Medicaid enrollment than states without such policies.

Top

Reproduction/infant parameters

We reviewed existing national, state and other data collection sources to delineate which available health indicators might be sensitive to welfare policies, as well as limitations related to the data sources and methodological constraints..

Top

PUBLICATIONS

The projects listed below vary greatly in size and scope: some are at the district or provincial level, others are national. All begin with needs assessments, which show in stark relief the lack of life-saving services for women. The findings are then translated into detailed project plans with governments and the medical community.

Recent Papers

Romero D, Chavkin W, Wise PH, Smith L, Wood P. Welfare to Work? Impact on Maternal Health on Employment. American Journal of Public Health. In press.

Chavkin W, Wise PH, Romero D. The Data Are In: Health Matters in Welfare Policy. American Journal of Public Health. In press.

Wise PH, Wampler N, Romero D, Chavkin W. Chronic Illness Among Poor Children Enrolled in the Temporary Assistance to Needy Families (TANF) Program. American Journal of Public Health. In press.

Smith L, Romero D, Wood P, Wampler N, Chavkin W, Wise PH. Child health employment barriers among welfare recipients and applicants with chronically ill children. American Journal of Public Health. 2002; 57 (3). In press.

Maine D, Chavkin W. Maternal Mortality: Global Similarities and Differences. Journal of the American Medical Women's Association. In press.

Pati S, Romero D, Chavkin W. Changes in Utilization of Health Insurance and Food Assistance Programs in Medically Underserved Communities in the Era of Welfare Reform: An Urban Study. American Journal of Public Health. In press.

Wood P, Smith L, Romero D, Bradshaw P, Wise P, Chavkin W. Children with Asthma: The Relationship Between Welfare Status, Health Insurance Status and Child Health. American Journal of Public Health. In press.

Chavkin W, Wise PH, Romero D. Welfare, Women, and Children: It's Time for Doctor's to Speak Out. Journal of the American Medical Women's Association. 2002; 57 (1): 3-4. Editorial.

Chavkin, W. Sex, Lies, and Silence: Reproductive Health in a Hostile Environment. American Journal of Public Health. 2001; 91 (11): 1739-1741.

Romero D, Chavkin W, Wise PH, Hess C, VanLandeghem K. State welfare reform policies and maternal and child health services: A national study. Maternal and Child Health Journal. 2001;5(3):199-206.

Chavkin W, Romero D, Wise PH. State welfare reform policies and declines in health insurance. American Journal of Public Health. 2000;90:900-908.

Chavkin W, Draut T, Romero D, Wise PH. Sex, reproduction and welfare reform. Georgetown Journal on Poverty Law and Policy. 2000;7(2):1-11.

Romero D, Chavkin W, Wise PH. The impact of welfare reform policies on child protective services: A national study. Journal of Social Issues. 2000;56(4):799-810.

Smith L, Wise PH, Chavkin W, Romero D, Zuckerman B. Implications of welfare reform for child health: emerging challenges for clinical practice and policy. Pediatrics. 2000;106(5):1117-25.

Wise PH, Chavkin W, Romero D. Assessing the effects of welfare reform policies on reproductive and infant health. American Journal of Public Health. 1999;89:1514-1521.

Chavkin W. What's a mother to do? welfare, work, and family. American Journal of Public Health. 1999;89:477-479. Editorial.

Chavkin W, Wise PH, Elman D. Welfare reform and women's health. American Journal of Public Health. 1998;88:1017-1018.

Chavkin W, Elman D, Wise PH. Mandatory testing of pregnant women and newborns: HIV, drug use and welfare policy. Fordham Urban Law Journal. 1998;24(4):749-755.

Chavkin W. Policies towards pregnancy and addiction: sticks without carrots. In Harvey JA, Kosofsky BE, eds. Annals of the New York Academy of Sciences. 1998;846:335-340.

Top

Policy briefs

DOCTORS SPEAK OUT

Endorsements
Download PDF

Executive Summary
Download PDF

Agenda
Download PDF

Top

 

LINKS

Below is a list of web sites that contain information concerning welfare reform.

Organizations

AJPH

Center for Law and Social Policy

Child Trends

General Service Foundation

JAMWA

Kaiser Family Foundation

National Governor's Association

NCCP

NOW Legal Defense and Education Fund

State Policy Documentation Project

The Ford Foundation

The Open Society Institute-NY

The Urban Institute

Welfare Information Network

 

Government Agencies

Administration for Children and Families

Center for Disease Control and Prevention

Department of Health and Human Services

Health Care Financing Administration

Health Resources and Services Administration

Maternal and Child Health Bureau

Office of Population Affairs

 

Top