KENTUCKY MOMS PARTNERSHIPâ„ GOALS & NEEDS ASSESSMENT RESULTS SUMMER 2019
WHAT IS MOMS? The MOMS Partnership® is a program that has successfully reduced depressive symptoms among over-burdened, under-resourced pregnant women, moms, and other adult female caregivers in a family (hereafter, “mothers”). Launched in New Haven in 2011 out of Yale, the MOMS Partnership brings mental health within reach of these women, literally meeting them where they are to help women and their families realize their full potential. Elevate is a policy lab at Yale dedicated to elevating mental health and disrupting poverty that is scaling MOMS to and with new communities in concert ultimately with government partners. The MOMS Partnership offers up to four interventions including coaching, parenting supports, job readiness skill-building, and eight weeks of cognitive behavioral therapy (CBT) in places like grocery stores, libraries, and after school programs (“neighborhood hubs”), where the program also conducts outreach and enrollment. Unlike many other social services, the MOMS Partnership reaches people in their own communities on their own terms. 1
At these neighborhood hubs, we provide mothers with resources like free diapers and shampoo to cover basic needs and connect mothers with social services and government benefits for which they are eligible. Partnerships with government agencies allow us to follow outcomes for participating families, including school attendance for example. This feedback is coupled by regular feedback from participants, who help fine tune the program for future cohorts. Participants experience empathy in the form of connection with other mothers in the group settings of the interventions delivered by a licensed clinician and a Community Mental Health Ambassador, a local mother who can culturally and emotionally accompany mothers on their journeys to improved well-being. Depression is hard. But it doesn't have to last forever. We help women who have struggled because every mother matters.
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WHAT IS THE KY MOMS GOALS & NEEDS ASSESSMENT? The MOMS Partnership is committed to meeting mothers where they are. The MOMS Goals & Needs Assessment is a survey that the MOMS Partnership co-creates and distributes in order for mothers in a community to share what they want, what they need, and what goals they have for themselves and their families. The Kentucky MOMS Partnership℠ Goals & Needs Assessment (“KY MOMS Goals & Needs Assessment”) was developed and distributed in the Summer of 2019 to local mothers via the collaboration between Elevate at Yale, the Kentucky Cabinet for Health and Family Services (CHFS), Kentucky Justice and Public Safety Cabinet (JPSC), and Kentucky Center for Statistics (KYSTATS). In the KY MOMS Goals & Needs Assessment, we asked mothers questions relating to themselves, their families, basic needs, employment and education, access to resources, and about their physical and emotional wellness. The survey was distributed on paper under Kentucky Department of Corrections supervision and required about 15 minutes of respondents’ time.
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Women were eligible to complete the survey if they are a parent, guardian, or primary caregiver of a child under 18 or are currently pregnant, identify as a woman, are at least 18 years of age, reside or are planning to reside in the Greater Louisville Area, and are under the supervision of the Kentucky Department of Corrections. 214 respondents took the KY MOMS Goals & Needs Assessment between July 10th and August 1st, 2019. The data were cleaned for analysis by Elevate in July 2019, excluding observations where survey respondents were not eligible or did not complete more than 50% of the survey. After cleaning, 176 eligible observations remained for analysis. These eligible observations correspond to “respondents� throughout this report. Analysis of the 176 eligible observations was completed by Elevate using the statistical software R 3.6.1 following an internal data analysis plan calculating frequencies, means, ranges of variables among observations, as well as associations between variables. The results of this analysis are included in this report.
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WHO CAN KY MOMS SERVE? Through the KY MOMS Goals & Needs Assessment, Elevate found that the KY MOMS Partnershipâ„ can serve: Mothers who self-report low levels of social support:
25.9%
31.8%
42.3% Low Social Support Moderate Social Support High Social Support
Mothers who screen as at risk for depression:
Respondents with CES-D score ≼ 16: 50.7%
Mothers who report experiencing difficulties accessing treatment for mental and emotional health:
CES-D greater than or equal to 16 indicates greater risk for clinical depression*
*The Center for Epidemiologic Studies Depression Scale (CES-D) is a screening tool used to assess depressive symptoms and probability of a depressive disorder. The range of possible scores is between 0 and 60. 5
45.7% of mothers
have wanted help for their emotional health but did not receive it.
Mothers were asked about their racial and ethnic background, the number of children that they care for, and their age. Respondents reported a range of racial and ethnic backgrounds, with the majority identifying as White and non-Hispanic.
3.4% 5.1%
64.2%
White, Non-Hispanic
Respondents ranged between 19 and 62 years of age
Average age of respondents:
33.8
27.3%
Black/African-American, Non-Hispanic White or Black/AfricanAmerican, Hispanic Other
Average number of children of respondents: Respondents had or cared for at least one child, with a range between 1 and 8 children
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2.0
WHAT HOPES & GOALS DO KENTUCKY’S JUSTICEINVOLVED MOTHERS HOLD? Respondents were asked for their goals for the next month and for the next year. The most popular responses fell into the following themes: Securing, maintaining, or improving employment (42.3%)
Finding stable housing or changing housing situation (32.7%)
Beginning, continuing, or graduating from school or GED (21.4%)
Maintaining sobriety (17.9%)
Completing a mental health, recovery, or rehab program (17.3%)
Gaining visitation, custody, or contact with children (17.9%)
Improving finances, paying bills, or saving money (13.1%)
Getting or fixing a car (13.1%)
The MOMS Partnership recognizes the importance of the hopes and goals of all mothers and their families, and seeks to assist mothers to achieve them through MOMS services. 7
WHAT NEEDS DO KENTUCKY’S JUSTICE-INVOLVED MOTHERS VOICE? Of all respondents:
63.9%
Screened positive for food insecurity
68.9%
Screened positive for housing insecurity
61.7%
Experience transportation barriers
86.4% reported ever receiving Medicaid coverage, 88.1% reported ever receiving SNAP benefits, and 54.0% reported ever receiving WIC benefits 61.2% reported currently receiving Medicaid coverage*, and 31.8% reported currently receiving SNAP benefits 48.8% of respondents reported that there was a time in the last 12 months where they were not able to pay the mortgage or rent on time * When asked about health insurance, 72.4% indicated Medicaid as their insurance provider. 8
In their own words, respondents struggle with:
“Being able to provide basic needs for my children” “Housing, insurance, community safety” “Housing for my daughter” “Doctor appointments, 40 hour a week jobs to provide, paying bills to have a roof over our heads” “Transportation, clothes, home” “Everything I need (I.D., social security card) to obtain employment” 9
Though many mothers who experience food, housing, and resource insecurity access government assistance programs and resources, many mothers still experience difficulties obtaining basic supplies for their children and supporting their own emotional health and wellbeing: 27.1% of respondents with children in diapers reported diaper need, the inability to provide a sufficient supply of diapers to change their child as often as they would like.
Respondents experiencing diaper need reported borrowing diapers or money (69.2%) from family or friends and getting diapers from an agency (30.8%) to meet their child’s diaper needs. Respondents who felt they have a sufficient supply of diapers reported borrowing diapers or money (37.1%) from family or friends in addition to purchasing diapers with their own money (68.6%) as reasons they have enough diapers. 31.6% of respondents reported that at least six months had passed since they did something for themselves that they enjoy, and 23.6% of respondents did not remember the last time that they did something for themselves that they enjoy. 10
TRANSPORTATION Of all respondents: 44.6% have a lost a job because they did not have transportation to get there 54.3% have missed a doctor’s appointment for themselves or their children because they did not have transportation to get there
A mother’s goal for the month:
“To attend all my appointments that I need to attend.”
Lack of transportation was the second most frequent reason for delaying medical care and for not receiving desired help for emotional health. Of those who travel to a job, mothers usually:
To get to doctor’s appointments, mothers usually:
Drive their own vehicle (42.2%)
Drive their own vehicle (40.9%)
Take the bus (34.8%)
Ride with someone (35.2%)
Get dropped off (24.4%)
Take the bus (32.9%)
Ride with someone (23.0%)
Get dropped off (27.3%)
Walk (23.0%)
Borrow a vehicle (18.2%) 11
EMPLOYMENT AND FINANCIAL INSECURITY Of all respondents: 43.3% reported working for pay at the time of survey and 61.3% of those working reported working full-time. Of mothers who work part time: 72.5% work between 11 and 30 hours per week 17.2% work more than 30 hours per week and 10.3% work 10 hours or fewer per week
A mother’s goal for the month:
“To be able to pay my bills on time. Have job stability. Spend more time with my family.”
48.8% screened positive for financial insecurity. Specifically, 48.8% indicated being unable to come up with any money if an unexpected need arose within the next month 34.7% indicated being able to come up with $500 if an unexpected need arose within the next month 10.4% indicated being able to come up with $1000 if an unexpected need arose within the next month 1.2% indicated being able to come up with $2000 if an unexpected need arose within the next month 4.9% indicated being able to come up with more than $2000 if an unexpected need arose within the next month 12
EMOTIONAL HEALTH AND ACCESS TO CARE A mother’s goal for the month:
“To get stable mentally to support myself and to be the mother my son deserves. Build a bond with my son that I had lost.”
Respondent self-rating of emotional health status 2.3%
7.4%
10.8%
Excellent Good
Of all respondents:
38.1%
76.1% reported having ever received treatment for stress, sadness, depression, anxiety, or any other emotional or mental health conditions
41.5%
Fair Poor Very Poor
54.6% rated their emotional health as fair, poor, or very poor 13
Of all respondents: 45.7% reported ever wanting help with their emotional health but not receiving it Of those respondents who reported ever wanting help with their emotional health but not receiving it: 55.0% reported that they could not get an appointment soon enough 43.0% felt that they had to wait too long to see a doctor after arriving 42.3% reported that services were not covered by their health insurance or they did not have health insurance 33.7% did not think they really needed it 25.6% felt they received treatment from a healthcare provider in the past that was worse than what others got Respondents were asked to choose all issues that applied.
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The needs of mothers impact other aspects of their lives, as suggested by statistically significant* associations found between basic need insecurity and depression. Depression among Mothers who Experience Food, Housing, and Financial Insecurity 25
Mean CES-D Score
20
20.1
21.5
19.9
CES-D ≼ 16 considered “at risk for depressionâ€?
15
10
13.1
14.8
14.3
Those without Insecurity Those Experiencing Insecurity
5
0
Food Insecurity Mothers were more likely to have higher depressive symptoms (p < .001) and to be at risk for depression (p = .007) if they were experiencing food insecurity.
Housing Insecurity Mothers were more likely to have higher depressive symptoms (p = .021) if they were experiencing housing insecurity.
Financial Insecurity
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Mothers were more likely to have higher depressive symptoms (p = .022) and to be at risk for depression (p = .022) if they were experiencing financial insecurity.
* Significance of an association was determined if p < 0.05
The needs of mothers impact other aspects of their lives, as suggested by statistically significant* associations found between barriers and depression.
Depression among Mothers with Transportation and Health Care Barriers 25
Mean CES-D Score
20
21.5
20.2
CES-D â&#x2030;Ľ 16 considered â&#x20AC;&#x153;at risk for depressionâ&#x20AC;? 15
14.6
14.5
10
Those without Barrier
5
Those with Barrier
0
Transportation Barrier
Mothers were more likely to have higher depressive symptoms (p = .006) and to be at risk for depression (p = .004) if they had one or more barrier to transportation.
Health Care Barrier
Mothers were more likely to have higher depressive symptoms (p < .001) and to be at risk for depression (p = .001) if they had one or more barrier to health care. 16
* Significance of an association was determined if p < 0.05
The needs of mothers impact other aspects of their lives, as suggested by statistically significant* associations found between social support and self-rated emotional health and depression. Depression among Mothers with Low Social Support
Depression and Self-Rated Emotional Health
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40
24.1 CES-D ≥ 16 considered “at risk for depression”
15
15.4
10
14.4
5
Mean CES-D Score
Mean CES-D Score
20
37.3
35
25
0
30 25 20
25.0 20.5
15 10
CES-D ≥ 16 considered “at risk for depression”
11.7 7.6
5 0
Poor
Moderate
Strong
Very Poor
Social Support
Fair
Good
Excellent
Self-Rated Emotional Health
Mothers were more likely to have higher depressive symptoms (p < .001) and to be at risk for depression (p < .001) if they had low (poor) social support. * Significance of an association was determined if p < 0.05.
Poor
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Mothers who gave low ratings of their own emotional health were more likely to have higher depressive symptoms (p < .001) and to be at risk for depression (p < .001).
The needs of these mothers impact other aspects of their lives, as suggested by statistically significant* associations found between style of coping with challenging situations and depression. Depression among Mothers who Tend to Self-Blame and Give Up in Response to Challenges
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Mean CES-D Score
35 30
Self-Blame in Response to Challenges Giving Up Trying to Deal with Challenges
25 20
CES-D ≥ 16 considered “at risk for depression”
15 10 5 0
2
3
4
5
6
7
8
Lowest Tendency Highest Tendency Score on Self-Blame or Behavioral Disengagement (“Giving Up”) Scale of Brief COPE Inventory Mothers were more likely to have higher depressive symptoms (p < .001) and to be at risk for depression (p < .001) if they had a high tendency to self-blame in response to challenges or give up trying to deal with challenges. 18
* Significance of an association was determined if p < 0.05
In sum, mothers who completed the KY MOMS Goals & Needs Assessment reported experiencing food, housing, and financial insecurity; transportation barriers; and difficulty accessing emotional or mental health resources. Aspects of their lives â&#x20AC;&#x201D; whether their experience of depressive symptoms, risk for depression, or employment status â&#x20AC;&#x201D; can be associated with many of these experiences. In the next section, mothers describe their lived experiences with these challenges in their own words.
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WHAT BRINGS JOY TO KENTUCKY’S JUSTICE-INVOLVED MOTHERS? Besides describing the challenges that they face, mothers also described what brings them joy in caring for their children. Respondents describe their experiences seeing their children happy and smiling, growing, learning and achieving milestones; receiving love and affection from their children; and teaching, providing love to, and spending time with their children.
“Seeing my children grow and hit milestones. Their joy brings me joy.” “I love hearing my kids laugh.” “Being able to give my children the life I never had growing up.” “Watching my daughter learn and grow. Spending time with my daughter.” “Seeing my kids happy and healthy. Taking them to the park and watching them play sports. Teaching them new stuff.” 20
WHAT ARE THE CHALLENGES THAT KENTUCKY’S JUSTICE-INVOLVED MOTHERS FACE? In describing the challenges that they face as a parent, mothers often included financial insecurity and ability to provide for their children, children’s behavior and discipline, single parenting, housing stability, and feelings of failure as a parent or fear that they will let their children down.
“Place to live, and want them to turn out better than me.”
“Scared I can’t provide for them and let them live normal [lives] because of a car or money.”
“Discipline, feeling like I failed.”
“Feeling that I let them down.”
“Not being able to pay my bills, finding a job. Their dad not being there is really hard.”
“Not going back to prison and/or disappointing my kids.”
“Trying to show my kids which direction is the right direction.”
“Homelessness, medical care.”
Other challenges that mothers reported included: addiction, separation from children, decision-making, reentry into children’s lives, children’s disability or mental health needs, and transportation. 21
WHERE DO KENTUCKYâ&#x20AC;&#x2122;S JUSTICE-INVOLVED MOTHERS FEEL WELCOME & COMFORTABLE? Respondents were asked to list up to three places in their community where they feel welcome and comfortable. The most popular responses fell into the following categories:
Church
Grocery Stores* (30.9%)
(23.7%)
(11.8%)
AA Meetings
Stores Other than Grocery
Home
Parks
(59.2%)
(11.2%)
Library
(10.5%)
(11.2%)
*Kroger in particular appeared in 9.9% of responses 22
Work
(10.5%)
WHAT PUTS KENTUCKYâ&#x20AC;&#x2122;S JUSTICE-INVOLVED MOTHERS AT RISK FOR RECIDIVISM? To supplement the GNA findings, we turned to the Kentucky Department of Corrections Risk and Needs Assessment data from 1,824 justice-involved women with dependents in Jefferson County.
54.7%
19.1%
15.0%
are at high neighborhood risk for are at high education & employment risk are at high substance use risk for recidivism: they are more likely to recidivism: they are more likely to for recidivism: they are more likely to recidivate because they live in recidivate because they have a recidivate because they experience high-crime areas where drugs are unemployment and financial instability, and history of drug or alcohol use readily available causing problems in their life have no high school diploma or GED However, neighborhood and substance use risk for recidivism differ for women of different racial identities: 67.1% of black women and 70.6% of biracial women have high neighborhood risk for recidivism, compared to 48.1% of white women (p < .001) 20.4% of white women demonstrate high substance use risk for recidivism, compared to 4.9% of black women and 2.9% of biracial women (p < .001) 23
Justice-involved women who are at high risk for recidivism based on certain factors— their education, employment, and social networks— are also more likely to be at high risk for recidivism because of their substance use.
Substance use is a strong risk factor for new crime. A woman is more likely to have high substance use risk for recidivism if she also has: high “peer association” risk for recidivism, meaning she is more likely to recidivate given her friends’ criminal history, gang membership, and social involvement in criminal activity (p = .01) high education & employment risk for recidivism, meaning she is more likely to recidivate given her low level of education and employment (p = .04)
35% 30% 25%
Percent with High Substance Use Risk
Women with High Peer Association Risk for Recidivism Have Higher Rates of Substance Use Risk for Recidivism
25%
32.7%
20%
20%
19.7%
15% 10%
9.5%
5% 0%
Women with High Education & Employment Risk for Recidivism Have Higher Rates of Substance Use Risk for Recidivism
High
Moderate
Percent with High Substance Use Risk
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15.4%
10%
10.2%
5% 0%
Low
Peer Association Risk Level
15%
20.5%
High
Moderate
Low
Education & Employment Risk Level
Justice-involved women who are at high risk for recidivism based on certain factors— their social networks and their family and social support— are also more likely to be at high risk for recidivism because of their criminal attitude. Criminal attitude, related to a woman’s level of concern for others’ wellbeing, risk-taking behavior, violence, and other characteristics, increases the likelihood that a woman will recidivate. A woman is more likely to have high criminal attitude risk for recidivism if she also has: high “peer association” risk for recidivism, meaning she is more likely to recidivate given her friends’ criminal history, gang membership, and social involvement in criminal activity (p = .003) high family & social support risk for recidivism, meaning she is more likely to recidivate given her family history, low relationship satisfaction, poor social support, and housing instability (p = .02) Women with High Family & Social Support Risk for Recidivism Have Higher Rates of Criminal Attitude Risk for Recidivism
Women with High Peer Association Risk for Recidivism Have Higher Rates of Criminal Attitude Risk for Recidivism 7% 6%
Percent with High Criminal Attitude Risk
5%
5%
6.1%
4% 3% 2% 1% 0%
0.2% High
6%
Moderate
0.0%
Percent with High Criminal Attitude Risk
Low
Peer Association Risk Level
25
4%
5.3%
3% 2% 1% 0%
High
0.5%
0.4%
Moderate
Low
Family & Social Support Risk Level
HOW CAN MOMS HELP? In New Haven, the MOMS Partnership has seen that: 76% of participants experience a decrease in depressive symptoms from beginning to end of MOMS. Of those experiencing a decrease, the average participant experienced a 48% drop in depressive symptoms. Participants have a 67% decrease in parenting stress from beginning to end of MOMS. Children of participants attend 6 more days of school per year compared to children of nonparticipants. The percentage of women working at least 15 hours a week dramatically increases after participating in MOMS â&#x20AC;&#x201C; from 15% at time of enrollment to 39% at six months after graduating from MOMS.
Elevate at Yale has partnered with the Kentucky Cabinet for Health and Family Services (CHFS), Kentucky Justice and Public Safety Cabinet (JPSC), and Kentucky Center for Statistics (KYSTATS), in collaboration with Centerstone, to co-create and soon launch the KY MOMS Partnershipâ&#x201E; . KY MOMS will assist justice-involved women in receiving the support and resources that they need to flourish as mothers and as members of their community. 26
WHAT ARE THE NEXT STEPS FOR THE KY MOMS PARTNERSHIP℠? The majority (66%) of those who responded to the KY MOMS Goals & Needs Assessment indicated that they would be interested in receiving more information about KY MOMS services in the future. A further 20% indicated that they might be interested. The findings of the KY Goals & Needs Assessment will strongly inform the delivery of the MOMS intervention. For example, selection of one-stop hub sites for MOMS services will be informed by the places in their community where mothers feel welcome and comfortable. Elevate will use the findings — as well as feedback from community partners and stakeholders — to tailor the KY MOMS services which are set to launch in early 2020. Ultimately, Elevate aims for the MOMS Partnership to be a useful and sustainable resource in Kentucky and to help improve the lives, mental health and wellbeing, and connectedness of mothers who live there.
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ACKNOWLEDGEMENTS Elevate thanks our partners at CHFS and the Department of Corrections Division of Reentry Services within JSPC for their instrumental work on the co-creation and distribution of the KY MOMS Goals & Needs Assessment. We thank KYSTATS for their support and guidance in the process. Elevate and the MOMS PartnershipÂŽ would also like to thank CHFS, JSPC, and KYSTATS for the opportunity to work together find ways to help and empower mothers and female caregivers. Most importantly, we offer our thanks to the mothers who took the time to share with us so much about their lives through the KY MOMS Goals & Needs Assessment.
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APPENDIX Elevate would like to note some additional findings from the KY MOMS Goals & Needs Assessment that provide insight into the lives of Kentucky justice-involved mothers who completed the survey: 100% of respondents identified English as the primary language they speak. 20.4% of respondents reported their marital status as either married or living with a partner, and 46.0% of respondents reported never being married. 29.1% of respondents reported renting their home or apartment, and 3.5% of respondents reported owning their own home. 23.6% of respondents reported living in three or more different places in the last 12 months. 24.7% of respondents reported there being a time in the last 12 months where they did not have a steady place to sleep or they slept in a shelter. Of those respondents who reported that they did not have a steady place to sleep or slept in a shelter in the last 12 months, 30.2% reported that their children lived with them at that time. 27.8% of respondents who reported transporting to their job or work activity reported having more than one form of transportation to get there. 72.4% of respondents reported insurance coverage through Medicaid and 17.2% reported having no health insurance coverage. 79.3% reported that their children receive health insurance coverage through KCHIP, Medicaid, or Medicare. 4.3% reported that their children do not have health insurance. 29
27.4% of respondents reported attending church or religious meetings at least a few times a month. 51.1% of respondents reported spending time in private religious activities, such as prayer, meditation, or Bible study, once a week or more. 65.7% of respondents endorsed the statement “My religious beliefs are what really lie behind my whole approach to life” as definitely true or tends to be true. 48.9% of respondents reported experiencing one or more barriers to receiving timely medical care. Those who reported delaying getting medical care did so because they couldn’t get an appointment soon enough (48.8%); didn’t have transportation (47.7%); it was not covered by insurance or did not have health insurance (47.0%); they couldn’t get through on the telephone (44.7%); the clinic/doctor’s office was not open when could get there (32.1%); they had to wait too long to see the doctor once they were in the office (25.5%);or they had previously received treatment that was worse than what others received (28.9%). 26.7% of respondents reported completing less than high school or some high school/GED classes; 29.1% of respondents reported completing high school or their GED, 36.6% of respondents reported completing some college or vocational school, and 7.6% reported being a college graduate. When asked the time of day they would prefer to receive services in the future from the MOMS Partnership in Kentucky, 31.2% of respondents reported preferring morning classes, 32.7% of respondents reported preferring afternoon classes, and 40.2% of respondents reported preferring evening classes. 30
For more information, please visit elevate.yale.edu and moms.yale.edu
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