VERMONT MOMS PA R T N E R S H I P â„ GOALS & NEEDS ASSESSMENT R E S U LT S 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, shelters, community colleges, libraries, and tax prep organizations (“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 VERMONT 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 family. The Vermont MOMS Partnership℠ Goals & Needs Assessment (“Vermont MOMS Goals & Needs Assessment”) was developed and distributed in the Summer of 2019 to local mothers via the collaboration between Elevate at Yale and the Vermont Department for Children and Families (DCF). In the Vermont 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 online to local mothers who were recruited via flyers and email from VT DCF and required about 15 minutes of respondents’ time. Respondents who successfully completed the survey were compensated with a $10 for their time. 3
To be eligible to complete the survey, respondents must be a parent/guardian or primary caregiver of a child under 18 or be in the third trimester of pregnancy; identify as female or transgender; be at least 18 years of age; and be a member of a household currently receiving Reach First, Reach Up, Reach Ahead, or Post-Secondary Education Program (PSE) benefits. 165 respondents took the Vermont MOMS Goals & Needs Assessment between May 15th and July 14th, 2019. The data were cleaned for analysis by Elevate in July 2019, excluding observations where survey respondents were not eligible or did not complete the survey. After cleaning, 138 eligible observations remained for analysis. These eligible observations correspond to “respondents� throughout this report. Analysis of the 138 eligible observations was completed by Elevate using IBM SPSS Statistics 24 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 VERMONT MOMS SERVE? Through the Vermont MOMS Goals & Needs Assessment, Elevate found that the Vermont MOMS PartnershipSM can serve: Mothers who self-report low levels of social support: 11.6%
26.8%
61.6%
Low Social Support Moderate Social Support High Social Support
Mothers who screen as at risk for depression:
Respondents with CES-D score ≼ 16: 43.5%
Mothers who report experiencing difficulties accessing treatment for mental and emotional health: 59.6% 51.1%
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
31.9%
Couldn't get an appointment soon enough
Didn't have transportation
Clinic/doctor's office wasn't open when you could get there
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.
4.3%
2.2%
Respondents ranged between 19 and 70 years of age
3.6%
Average age of respondents:
34
White, Non-Hispanic
2.9%
Black or African-American, Non-Hispanic
Respondents had or cared for at least one child, with a range between 1 and 5 children
White or Black or AfricanAmerican, Hispanic Native American
87.0%
Other
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2.1
Average number of children of respondents
WHAT HOPES AND GOALS DO VERMONT 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 employment or finding a job
Moving or changing housing situation
Improving finances and paying bills or increasing savings
Beginning, continuing, or graduating from school
Seeing physical or mental health provider
Getting a driver’s license or vehicle
Improving their parenting
Exercising or losing weight
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 VERMONT MOTHERS VOICE? Of all respondents:
65.9%
Screened positive for food insecurity
51.4%
Screened positive for housing insecurity
89.9% reported ever receiving 3SquaresVT benefits, 88.4% reported ever receiving Women, Infants, and Children (WIC) benefits, and 61.6% reported ever receiving free or reduced price school lunch 42.8% 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 60.1% reported ever receiving help with rent (a housing subsidy or voucher) 34.1% are currently receiving assistance from the Burlington Housing Authority and 19.6% are currently receiving assistance from the Vermont State Housing Authority 8
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: 44.1% 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.
Those respondents with children in diapers report borrowing diapers or money from family or friends, stretching the diapers that they have, and getting diapers from an agency to meet their child’s diaper needs. 23.2% of respondents reported that at least six months had passed since they did something for themselves that they enjoy, and 22.5% of respondents did not remember the last time that they did something for themselves that they enjoy.
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TRANSPORTATION Of all respondents: 31.9% have a lost a job because they did not have transportation to get there 54.3% have had to miss a doctor’s appointment for themselves or their children because they did not have transportation to get there Lack of transportation was the most frequent reason for delaying medical care and the 2nd most frequent reason for not receiving desired help for emotional health. 68.1% of respondents reported experiencing at least one transportation issue in the last 6 months. 31.9% reported experiencing two or more transportation issues.
Of those respondents who experienced a transportation issue in the last 6 months: 43.6% did not have access to a vehicle 39.4% did not have a valid driver’s license 36.2% had an unreliable vehicle 22.3% had outstanding fines Respondents who indicated transportation issues were asked to choose all that applied. 10
CHILD CARE Of all respondents: 47.1% reported that issues with child care limited their ability to work or go to school in the last 12 months. 64.5% reported experiencing a child care issue in the last 12 months. 37.0% reported experiencing two or more child care issues in the last 12 months. Of those respondents who experienced a child care issue in the last 12 months: 56.2% could not find child care available for the times needed 49.4% indicated that the cost was too high 36.0% were concerned about an unsafe environment for their child(ren) 30.3% indicated that child care was too far from home/work Respondents who indicated child care were asked to choose all issues that applied.
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EMPLOYMENT AND FINANCIAL INSECURITY Of all respondents: Only 23.9% reported working for pay at the time of survey, and 45.5% of working women reported working full-time. 24.2% of working women worked as nursing assistants/home health aides and 21.2% worked in retail. 56.6% of the working women earned less than $14/hour and 84.8% earned less than $21/hour. 79.0% screened positive for financial insecurity.* Specifically, 41.3% indicated not being able to come up with any money if an unexpected need arose within the next month, while 37.7% felt they could come up with only $75. * Defined as the ability to come up with $75 or less if an unexpected need arose in the next month
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EMOTIONAL HEALTH AND ACCESS TO CARE Of all respondents:
Respondent rating of emotional health status
77.5% reported having ever received treatment for stress, sadness, depression, anxiety, or any other emotional or mental health conditions.
3.6%
12.3%
45.7% rated their emotional health as fair, poor, or very poor.
12.3%
Excellent Good Fair
29.7%
41.3%
Poor Very Poor
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Of all respondents: 34.1% reported ever wanting help with their emotional health but not receiving it. 26.8% reported experiencing two or more barriers to receiving help with their emotional health. Of those respondents who reported ever wanting help with their emotional health but not receiving it (47): 59.6% couldn’t get an appointment soon enough 51.1% didn’t have transportation 31.9% found that the clinic/doctor’s office wasn’t open when they could get there 29.8% did not think they really needed it 27.7% felt they received treatment from a provider in the past that was worse than what others got 25.5% did not have health insurance coverage for services or did not have any health insurance 19.1% missed too many appointments and providers would no longer work with them Respondents were asked to choose all issues that applied. 14
The needs of mothers impact other aspects of their lives, as suggested by statistically significant* associations found between: Mother’s experience of food insecurity
AND
increased depressive symptoms
p = 0.010
Mother’s experience of diaper need
AND
increased depressive symptoms
p = 0.043
Mother’s experience of any barrier to receiving health care
AND
increased depressive symptoms
p = 0.028
Mother’s experience of financial insecurity**
AND
increased depressive symptoms
p = 0.015
* Significance of an association was determined if p < 0.05. ** Defined as the ability to come up with 75 dollars or less if an unexpected need arose in the next month
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The needs of mothers impact other aspects of their lives, as suggested by statistically significant* associations found between:
Mother’s experience of low social support
AND Both
increased depressive symptoms being at risk for depression**
Mother’s low rating of her own emotional health
p = 0.001
increased depressive symptoms
p = 0.001
being at risk for depression**
p = 0.001
AND Both
* Significance of an association was determined if p < 0.05. ** Status of being “at risk for depression” is determined by CES-D score ≥16. 16
p = 0.001
The needs of these mothers impact other aspects of their lives, as suggested by statistically significant* associations found between: Mother’s current unemployment
Mother’s experience of missing a doctor’s appointment due to transportation issues
AND Both
AND Both
increased depressive symptoms
p = 0.005
being at risk for depression**
p = 0.004
increased depressive symptoms
p = 0.002
being at risk for depression**
* Significance of an association was determined if p < 0.05. ** Status of being “at risk for depression” is determined by CES-D score ≥16. 17
p = 0.014
In sum, mothers who completed the Vermont MOMS Goals & Needs Assessment reported experiencing food, housing, financial, and diaper insecurity; transportation and child care issues; and difficulty accessing emotional or mental health resources. Aspects of their livesâ&#x20AC;&#x201D;whether their experience of depressive symptoms, risk for depression, or employment statusâ&#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 ARE THE CHALLENGES THAT MOTHERS IN VERMONT FACE? In describing the challenges that they face as a parent, mothers often included financial insecurity, children’s behaviors, parenting challenges, and living as a single parent. “Behavioral issues with my oldest, and the overwhelming feeling of being a single mother.” “Not always being financially stable. Money is very, very tight.” “Sometimes I feel like I dont know how to discipline him the best, one of my biggest obstacles as a parent." “I am a single mom of 2 boys under 2. Stressful doing things by myself and when one crys the other does and sometimes I wanna cry myself.” “Being a single parent isnt easy hard to make ends meet with just one income. Also its hard to play both roles as mom and dad sometimes.” Other challenges that mothers reported included: finding appropriate childcare, children’s and maternal health issues, transportation issues, challenges of custodial/non-biological parenting, lack of time, lack of sleep, lack of support, employment issues, housing issues, and lack of self-care. 19
WHAT BRINGS JOY TO MOTHERS IN VERMONT? 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 learning, growing, developing, smiling, happy, thriving, and healthy as joyful, as well as spending time together, teaching and guiding them, and both giving affection to and receiving affection from their children. “Watching my daughter meet and complete milestones.” “Being and playing with my kids, seeing them happy and successful.” “Watching my kids develop and grow, nurturing them, and giving as well as receiving the unconditional love that comes with parenting.” “Being able to teach my boys things and watching them teach me things everyday.” “The smile of my baby girl.” “Thriving happy children.”
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WHAT DO MOTHERS IN VERMONT DO THAT THEY ENJOY? Respondents were asked what they do for themselves that they enjoy. The most popular responses fell into the following themes:
Going Outside 23.6%
Going to Salon/Spa 22.6%
(e.g., taking walks)
(e.g., getting nails done)
Doing Relaxing Activities at Home 12.3% (e.g., reading)
Spending Time with Friends 10.4%
Spending Time with Family 16.3%
Going to Restaurants 9.4%
Going to Entertainment Venues 13.2% (e.g., going to movies)
Making Arts and Crafts/Music 9.4%
Percentages reflect percentage of respondents to the question who mentioned the theme. A single respondent may have referenced several themes in their response; percentages do not add to 100.
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WHERE DO MOTHERS IN VERMONT FEEL WELCOME AND 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 themes:
(e.g., Hannaford)
Other Stores 31.7% (e.g., Dollar General)
Community Resource Providers 30.0% (e.g., Howard Center)
Church/Mosque 17.5%
Physical and Mental Health Providers 16.7%
School or Childrenâ&#x20AC;&#x2122;s School 13.3%
Family or Friendsâ&#x20AC;&#x2122; Homes 9.2%
Library 8.3%
Grocery Stores 58.3%
Percentages reflect percentage of respondents to the question who mentioned the theme. A single respondent may have referenced several themes in their response; percentages do not add to 100.
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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 – from 15% at time of enrollment to 39% at six months after graduating from MOMS.
Elevate at Yale has partnered with Reach Up at the Vermont Department for Children and Families, in collaboration with Howard Center, to cocreate and soon launch the Vermont MOMS Partnership℠. Vermont MOMS will assist mothers in receiving the support and resources that they need as part of Reach Up’s mission to join families on their journey to overcome obstacles, explore opportunities, improve their finances and reach their goals. 23
WHAT ARE THE NEXT STEPS FOR THE VERMONT MOMS PARTNERSHIP℠? The findings of the Vermont 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. Mothers taking the Goals & Needs Assessment named grocery stores, other stores, church/mosque, healthcare providers, their school or children’s school, family or friends’ homes, the library, and community resource providers as some of these places. Elevate will use the findings—as well as feedback from community partners and stakeholders—to tailor the Vermont MOMS services which are set to launch in early 2020. 97% of those who responded to the Vermont MOMS Goals & Needs Assessment indicated that they would be interested in receiving more information about Vermont MOMS services in the future.* Ultimately, Elevate aims for the MOMS Partnership to be a useful and sustainable resource in Vermont and to help improve the lives, mental health and wellbeing, and connectedness of mothers who live there. * This percentage refers to the total 165 respondents to the survey, as interest forms were collected separately from eligibility information. 24
ACKNOWLEDGEMENTS Elevate thanks our partners at Reach Up at the Vermont Department for Children and Families (DCF) for their instrumental work on the co-creation and distribution of the Vermont MOMS Goals & Needs Assessment. Our sincere gratitude also goes to the Howard Center and to other community organizations who contributed feedback along the way. Elevate and the MOMS PartnershipÂŽ would also like to thank DCF and the Vermont Agency for Human Services 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 Vermont MOMS Goals & Needs Assessment.
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APPENDIX Elevate would like to note some additional findings from the Vermont MOMS Goals & Needs Assessment that provide insight into the lives of Vermont mothers who completed the survey: 98.6% of respondents identified English as the primary language they speak. 26.8% of respondents reported their marital status as either married or living with a partner, and 50.7% of respondents reported never being married. 69.6% of respondents reported renting their home or apartment, and 8.7% of respondents reported owning their own home. 30.4% of respondents reported living in two or more different places in the last 12 months. 15.9% 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, 95.5% reported that their children lived with them at that time. 61.2% of the respondents who reported transporting to their job or work activity did so by by driving their own vehicle, and 25.4% reported doing so by taking the bus. 28.4% of respondents who reported transporting to their job or work activity reported having more than one form of transportation to get there. 90.6% of respondents reported receiving Medicaid/Dr. Dynasaur and 7.2% reported receiving Medicare health insurance coverage. 92.8% reported that their children receive Medicaid/Dr. Dynasaur health insurance coverage. 26
45.5% of the respondents who are currently working for pay were very satisfied and 42.2% were satisfied with the work they are currently doing. 11.6% of respondents reported attending church or religious meetings at least a few times a month. 17.4% of respondents reported spending time in private religious activities, such as prayer, meditation, or Bible study, once a week or more. 68.8% of respondents reported experiencing one or more barriers to receiving timely medical care. Those who reported delaying getting medical care did so because they didnâ&#x20AC;&#x2122;t have transportation (64.2%); couldnâ&#x20AC;&#x2122;t get an appointment soon enough (48.4%); did not think they really needed care (34.7%); had to wait too long to see the doctor once they were in the office (29.5%); clinic/doctorâ&#x20AC;&#x2122;s office was not open when could get there (26.3%), it was not covered by insurance or did not have health insurance (26.3%), had previously received treatment that was worse than what others received (17.9%), and missed too many appointments and provider will no longer work with you (13.7%). 39.1% of respondents reported completing high school or their GED, 30.4% of respondents reported completing some college or vocational school, and 13.8% reported being a college graduate or having completed more than college. When asked the time of day they would prefer to receive services in the future from the MOMS Partnership in Vermont, 45.7% of respondents reported preferring morning classes, 30.4% of respondents reported preferring afternoon classes, and 22.5% of respondents reported preferring evening classes. 27
For more information, please visit elevate.yale.edu and moms.yale.edu
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