Underprivileged & Underserved: The Impact of Poverty on ... · community – Securing...

Underprivileged & Underserved: The Impact of Poverty on Mental Health

3/30/2016

Kara Dean-Assael, LMSW Yvette Kelly, LMHC

Lydia Franco, LMSW

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Agenda • What is Poverty? • Who is affected by Poverty? • What is the link between Poverty and Mental Health?

– Children – Poverty Related Stress

• The Role of the Organization – The Business Case – Helpful Approaches

• The Provider’s Role • Resilience

Poverty Employment Food Security Housing Stability

Poverty: A Key Social Determinant

Let’s Chat:

What Does It Mean To Be Poor? – Please chat your answers into the ‘Chat Box’

to the Right!

Poverty is…

What Does it Mean to be Poor? • Limited access to financial resources - income - wealth • Limited access to other kinds of resources or capital - material resources (e.g., housing, clean water) - human resources (e.g., health care, education) - social resources (e.g., powerful networks)

What Does it Mean to be Poor? • Lack of protection from environmental hazards

– teratogens – blighted neighborhoods – natural disasters

• Lack of protection from social hazards – violence – coerced participation in demeaning or dangerous activities – daily hassles and unstable circumstances

Poverty Rate by Race/Ethnicity

Location White Black Hispanic Other Total

United States 10% 27% 24% 14% 15%

Kaiser Family Foundation estimates based on the Census Bureau's March 2014 Current Population Survey (CPS: Annual Social and Economic Supplements).

Poverty Rate by Age

Location Children 0-18 Adults 19-64 65+ Total

United States 21% 13% 10% 15%

Kaiser Family Foundation estimates based on the Census Bureau's March 2014 Current Population Survey (CPS: Annual Social and Economic Supplements).

What the Research Tells Us Disparities continue to exist- • 49% of American children in urban areas (9.7 million) live in low income families. Families of color are disproportionally represented in impoverished urban neighborhoods. • Black and Latino families with children are more than twice as likely as white families with children to experience economic hardships.

Source: U.S. Department of Commerce, Bureau of the Census, “Income, Poverty, and Health Insurance Coverage in the United States: 2006 ,” Current Population Reports, P60-233 (August 2007, Table B-2.

THE LINK BETWEEN POVERTY AND MENTAL

HEALTH

Mental Health

Poverty

The odds of a household experiencing food insecurity increased by 50 to 80 percent if a mother had moderate to

severe depression.

As a child or youth from a family living in poverty, you are 2-3x more likely to have a

mental health problem than that of a child

from a family that is not living in poverty.

What the Research Tells Us

Physical Problems

Cognitive Problems

Social/Emotional Problems

Behavioral Problems

anxiety, difficulty getting along with peers and adults, and low self-esteem

low birth weight, substandard nutrition, poor motor skills, and more accidents and injuries poor academic performance, especially among younger children, and higher drop-out rates in high school engagement in high-risk activities like smoking, alcohol and drug abuse, and early sexual activity, leading to higher rates of teen pregnancies

Poverty places children at greater risk for:

Poverty Related Stress • Poverty has an indirect effect on child and

adolescent functioning through poverty related stress

• Poverty is stressful for children as young as 6.

Stressed Brains

Our Brains on Stress Can’t effectively:

•Respond

• Learn

• Process

Children & Poverty

Understanding the link between poverty and child/youth mental health is essential since mental

illness is commonly associated with broad impairment lasting well into adulthood that have high costs to

society.

Poll Question: Do We as Providers Have a Role in

Attending to the Link Between Poverty and Mental Health?

A. Yes B. No C. I don’t know D. Yes, but I don’t know how

WHAT IS OUR ROLE?

The Business Case: The Bottom Line

The ability to attract and provide services for underserved clients is also a financial issue.

• Treatment Inefficiencies – Longer lengths of stay – Access & Capacity - inability to serve additional

clientele – Not identified as the provider of choice – Limited ability to engage in program improvement

The Business Case: The Bottom Line

• Pay for performance – Will be the method for addressing quality of care – Payors, in their contracting, will require providers

develop systems to monitor quality and address disparities

– This will be critical to obtain payment

The Business Case: The Bottom Line

• Avoidable Hospitalizations – Those who lack resources and are ineffectively

engaged tend to utilize high cost services. This issue will take on greater financial risk as CMS may decide to limit or refuse reimbursement for patients who are readmitted to the hospital within 30 days of discharge.

The Business Case: The Bottom Line

Examine agency policies to determine

if they may be inadvertently limiting

access to the disenfranchised

Policies

Do you recruit, retain, and promote a diverse group of

staff with knowledge, skills, and experience

in serving diverse populations?

Staffing

Has your agency identified and

articulated engagement

practices/standards for staff to utilize

when serving hard to reach populations?

Delivery

Our Agency… Improve access to care and services Examine organizational culture and the programs sensitivity to serving individuals who are economically disadvantaged.

– How are your Admission, Discharge, and No Show Policies structured?

– How are your staff (clinicians, front desk staff) instructed to address people who arrive late due to transportation issues?

– How are staff encouraged to attend to the concrete needs of those they serve who are burdened with the daily stress of living without?

– Are staff trained on addressing their own biases and judgements in the clinical decision-making process?

Considerations

Our Agency… – Providing services in the home and/or

community – Securing transportation (e.g., passes,

medicab, friends, family, other providers) – Implementing creative strategies that

result in the provision of free day-care services (for dependent children) during specific hours when clients receive services.

– Relationships with local food pantries and shelters

– Emergency food and clothes in house

Helpful Approaches

Helpful Approaches

Use Data to Improve Access and Use of Services

• The success of ones work hinges on the use of proper data and technology to identify and track the outcomes of the individuals being served. – Target patients in greatest need – Make data on participants actionable by generating alerts

to providers about patient care needs – Facilitate exchange of information with other providers on

the treatment team • Connect demographic data (race/ethnicity, SES, language

preference) to quality data (engagement, outcomes) to identify disparities in quality of care

Ineffective Practices

Despite the high rates of mental health problems manifested by the underprivileged in the United States, people living in poverty routinely

underutilize counseling services and often prematurely terminate counseling when they do access such services (Coiro, 2001; Gonzalez, 2005).

Not understanding client’s circumstances can lead to treatment plans that clients cannot follow.

Practitioners need to take sufficient time in establishing a therapeutic alliance: • Communicating a genuine sense of respect • Address, early in the helping process, specific

issues that are associated with living in a culture of poverty

• Refraining from placing an overemphasis on the individual client’s responsibility for being disadvantaged

• An appreciation of the multiple systems that impact that client’s life

• Giving practical and concrete suggestions for dealing with the unique needs of people living in poverty

How often do we ask?

• Do you have trouble making ends meet? • Do you have trouble feeding your family? • Do you have trouble paying for medications? • Do you have legal or immigration challenges? • Do you have a safe and clean place to live? • Have you applied for any and all applicable

benefits and assistance?

http://healthprovidersagainstpoverty.ca

The odds of a household experiencing food insecurity increased by 50 to 80 percent if a mother had moderate to

severe depression.

Resilience!

• Resilience studies find that people living in poverty commonly use a range of coping strategies that contribute to their psychological health, even in the face of unimaginable obstacles to their well-being (Buckner et al., 2003; Seccombe, 2002).

• These coping skills are natural starting points for providers and participants to explore and build on when faced with stressors that adversely affect the health and well-being of this population.

Resources

• Basic Needs Calculator (calculates how much families need to have basic necessities) – http://www.nccp.org/tools/frs/budget.php

• Earned Income Tax Credit – http://www.aecf.org/resources/building-family-economic-

success-the-earned-income-tax-credit-eitc/

• Poverty Simulation Game: www.playspent.org

Resources

• Smith, L. (2009). Enhancing training and practice in the context of poverty. Training and Education in Professional Psychology, 3, 84–93.

• Amatea, E. S., & West-Olatunji, C. A. (2007). Joining the conversation about educating our poorest children: Emerging leadership roles for school counselors in high-poverty schools. Professional School Counseling, 11, 81–89.

• Buckner, J. C., Mezzacappa, E., & Beardslee, W. R. (2003). Characteristics of resilient youths living in poverty: The role of self-regulatory processes. Development and Psychopathology, 15, 139–162.

• http://www.quantumunitsed.com/materials/1431_0221_Trauma-Urban_Poverty.pdf

• http://www.childtrends.org/wp-content/uploads/2010/10/Child_Trends-2010_10_05_RB_AssessingStress.pdf

• TED Talks: https://www.youtube.com/watch?v=kHIq-8J2K0Q

Questions

Upcoming Webinars

April 15, 2016 1-2pm

Mental Health Issues in LGB Populations: Minority Stress, the Coming Out Process, and LGB-Sensitive Therapy

April 28, 2016 12-1pm

How Racism Impacts Those We Serve and How We Serve

Obtaining 1 Social Work CE • Log in to the NYU Silver School’s CE Online Portal with your

Username and Password or to Create an Account: • https://sswforms.es.its.nyu.edu/

• Select today’s webinar under “All Events” • Complete any requested information and pay $15 processing fee • Within 24-48 hours, you will be notified to log in and take post-test • Complete post-test and follow instructions to receive your certificate • Note: The system works best with Google Chrome or Mozilla Firefox

Attendees will receive an email with this information within

one day of the webinar.

You should be logged in to the webinar under your name to receive credit for attendance.

Contact Us

Kara Dean- Assael kara.dean@nyu.edu

Yvette Kelly

yvette.kelly@nyu.edu

Lydia Franco lydia.franco@nyu.edu