Teaching the Importance and Use of Web-Based ...

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Teaching the Importance and Use of Web-Based Services to Assist Clients in Obtaining Public Benefits a

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Mary Keegan Eamon , Chi-Fang Wu , Gabriela Moroney & Melissa Cundari

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School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA b

Access Community Health Network, Chicago, Illinois, USA

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Feeding America, Chicago, Illinois, USA Version of record first published: 04 Apr 2013.

To cite this article: Mary Keegan Eamon , Chi-Fang Wu , Gabriela Moroney & Melissa Cundari (2013): Teaching the Importance and Use of Web-Based Services to Assist Clients in Obtaining Public Benefits, Journal of Teaching in Social Work, 33:2, 143-158 To link to this article: http://dx.doi.org/10.1080/08841233.2013.777011

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Journal of Teaching in Social Work, 33:143–158, 2013 Copyright © Taylor & Francis Group, LLC ISSN: 0884-1233 print/1540-7349 online DOI: 10.1080/08841233.2013.777011

Teaching the Importance and Use of Web-Based Services to Assist Clients in Obtaining Public Benefits MARY KEEGAN EAMON and CHI-FANG WU School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA

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GABRIELA MORONEY Access Community Health Network, Chicago, Illinois, USA

MELISSA CUNDARI Feeding America, Chicago, Illinois, USA

Research suggests that social work students and practitioners are not particularly sensitive to assessing clients’ economic hardship, nor when needed to assist clients in accessing relevant resources such as public benefits. To enhance students’ understanding of the importance of engaging in these activities, this article provides educational content on the frequent occurrence and negative effects of poverty, advantages of receiving public benefits, barriers to program participation, and social work values and educational requirements. Examples of web-based services, an efficient strategy to assist economically disadvantaged clients in accessing public benefits, are then provided. Finally, teaching applications are drawn from the previous sections. KEYWORDS information technology, web-based services, public benefits barriers

An estimated 43.7 million people (14.3% of the population) in the United States live in poverty. An even higher percentage of children (20.7%) are poor (U. S. Census, 2010). As social work students learn in their social policy Address correspondence to Mary Keegan Eamon, School of Social Work, University of Illinois at Urbana-Champaign, 1010 W. Nevada St., Urbana, IL 61801, USA. E-mail: eamon@ illinois.edu 143

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courses, the government provides a variety of means-tested public benefits to ease economic hardship. Even when economic resources are necessary to successfully carry out agreed tasks (Eamon & Zhang, 2006), students and practitioners are not always sensitive to assessing environmental factors and the availability of economic resources (Grinnell & Kyte, 1975; Rosen, 1993; Rosen & Livne, 1992). Researchers in Israel also found that approximately 33% of social work students believed that assisting clients in attaining basic needs should not be a responsibility of social workers (Krumer-Nevo & LevWiesel, 2005). However, students’ willingness to advocate for basic needs was found to be related to the available means to do so. A subsequent Israeli study (Weiss-Gal & Gal, 2009) found that although social workers engaged in a moderate level of assisting clients in obtaining public benefits, they attributed a higher level of professionalism to “intrapsychic intervention.” Not surprisingly, social workers who perceived such advocacy as a legitimate professional activity were more likely to engage in it. These studies suggest the need for social work educators to provide course content that stresses the importance of assessing clients’ economic hardship and to stress that connecting clients to resources is an appropriate professional activity. We begin by providing instructional knowledge to enhance students’ understanding of the importance of assessing whether clients’ basic needs are being met and of assisting clients in accessing public benefits when needed. We then discuss web-based services (an efficient way for social workers to assist clients in applying for public benefits) as one source of economic/material assistance. Finally, teaching applications are drawn from the two previous sections. This section provides content that instructors can use to convey to social work students the importance of assessing clients’ economic and material hardship and to assist clients in obtaining public benefits that can reduce identified hardships.

RISKS AND EFFECTS OF ECONOMIC HARDSHIP The previously cited annual percentages of the U.S. population living in poverty underestimate the occurrence of economic hardship. The majority of adults (58.5%) live in poverty at some time during adulthood, and 68% experience economic conditions below 125% of poverty, as defined by the government (Rank, Yoon, & Hirschl, 2003). During childhood, an estimated 34% of children live at least 1 year in poverty, and 40% live at least 1 year at 125% of poverty (Rank & Hirschl, 1999). Multiple studies link child poverty with socio-emotional problems, impaired cognitive development, health problems, and low educational achievement (Magnuson & Votruba-Drzal, 2009; Seccombe, 2000), and with poor health, criminal activity, and low-wage employment (Holzer,

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Schanzenbach, Duncan, & Ludwig, 2007). Adult poverty also has been shown to increase depression, marital dissolution, and harsh, emotionally unsupportive parenting practices (McLoyd, 1990; Rank, 2001). Other studies demonstrate that experiencing material hardship, such as the inability to access adequate food, obtain access to medical and dental care, and to live in sound housing, all affect a wide variety of undesirable outcomes. These include psychological distress (Heflin & Ziliak, 2008), cognitive declines among older adults (Sachs-Ericsson, Corsentino, & Cougle, 2009), and a decrease in parental well-being, which will affect their children (Gershoff, Aber, Raver, & Lennon, 2007). Understanding that living in or near poverty is a common event can provide a rationale for students to regularly assess clients’ economic hardship and to assist them in its alleviation.

ADVANTAGES OF PUBLIC BENEFITS Clients can gain a number of advantages by receiving public benefits. Receipt of such benefits lifts approximately 11 million Americans out of poverty (Sherman, 2005). The Earned Income Tax Credit (EITC) and child care subsidies increase single mothers’ employment (Ellwood, 2000; Tekin, 2005), and the EITC enhances social mobility by supporting activities such as college enrollment (Smeeding, Phillips, & O’Connor, 2000). For low-income families, Supplemental Security Income (SSI) covers individuals at least 65 years old or disabled, supports community living, and assists families in caring for individuals with disabilities (Sweeney & Fremstad, 2005). Federal food assistance programs increase the availability of nutritious food (USDA, 2006) and enhance children’s academic performance (Frongillo, Jyoti, & Jones, 2006). Receipt of WIC benefits improves child nutrition and decreases the birth of low-birth-weight infants (American Dietetic Association, 2006). Receiving either food stamps or WIC benefits lowers the risk of child health problems and of child maltreatment (Lee & Mackey-Bilaver, 2007). For children and persons with severe and persistent mental illness, receipt of public health insurance increases access to health and mental health services (Dick et al., 2004; Frank, Goldman, & Hogan, 2003). Finally, subsidized housing programs can reduce homelessness (Schwartz, Ellen, Voicu, & Schill, 2006). In addition, providing basic needs to clients can strengthened the clientsocial worker relationship (Krumer-Nevo & Lev-Wiesel, 2005) and increase the families’ time and energy, allowing parents to benefit from intangible services (Bartle, Couchonnal, Canda, & Staker, 2002). From clients’ perspectives, the importance of providing economic-related resources is further highlighted in other studies (Paris, 2008). A review of child welfare intervention research also indicates that providing concrete services is as (or more) effective in producing positive outcomes than typical family preservation services (Chaffin, Bonner, & Hill, 2001). Finally, because some interventions

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(such as parent management training) are less effective with low-income clients (Eamon & Venkataraman, 2003), increasing these clients’ economic resources may enhance the overall effectiveness of professional intervention.

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TAKE-UP RATES AND BARRIERS Despite the importance of receiving public benefits, many eligible households do not receive them. According to recent government reports,” take-up rates” for entitlement programs, which provide benefits to all applicants meeting program eligibility, range from 67% for the food stamp program (currently referred to as the Supplemental Nutrition Assistance Program [SNAP]) to 75% for the EITC (Leftin, 2010). Take-up rates for Medicaid and SSI range from approximately 66% to 73% (USGAO, 2005). Non-entitlement programs, which are dependent on meeting program eligibility as well as funding availability, tend to have even lower take-up rates. These rates include Public Housing, 7% to 9%; Housing Choice Vouchers, 13% to 15%; the Child Care and Development Fund, 18% to 19%; State Children’s Health Insurance Program, 44% to 51%; the WIC program, 51% to 55%, and Temporary Assistance to Needy Families, 40% (USDHHS, 2008). Hernanz, Malherbet, and Pellizzari (2004) conceptualized the failure of eligible households to receive public benefits as falling into four categories: pecuniary determinants, information cost, administrative cost, and social and psychological costs. Pecuniary determinants involve the amount and duration of benefits. As might be expected, when the benefit is small and duration is short, take-up rates are low. Information costs that lower program participation include lack of program knowledge, such as the available benefits and eligibility rules, and complex application procedures (e.g., Stuber & Kronebusch, 2004; USGAO, 2005). Administrative costs, which also can decrease take-up rates, include the perceived waiting time for receiving the benefit and the uncertainty of the outcome. Other administrative costs include the lack of accommodations for applicants with limited English proficiency; burdensome eligibility verification, and recertification requirements; and similar transaction costs (McKean, 2002; USGAO, 2005). Finally, social and psychological costs involve feelings of discomfort, negative past experiences, and social stigma (Heflin & Ziliak, 2008; Stuber & Kronebusch, 2004). Among these factors, information, administrative, and social and psychological costs can be assessed and addressed at the agency level.

SOCIAL WORK VALUES AND EDUCATIONAL REQUIREMENTS Finally, instructors can enhance students’ understanding of the importance of assisting clients in obtaining public benefits by affirming the consistency

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of such activity with the core values of the profession. Historically, social work has been concerned with poverty, the adverse effects of economic hardship on individuals and families (Brieland, 1995), and the universal right to basic needs (Craig, 2002). Such concerns are reflected by the core value of social justice in the National Association of Social Workers Code of Ethics (2009), the International Federation of Social Worker’s definition of social work (Hare, 2004), and the purpose of the social work profession, as stated in the Council on Social Work Education’s (2010) educational policy and accreditation standards. Social workers are expected to advocate for economic justice, work to reduce poverty, and assist others in accessing benefits and entitlements.

WEB-BASED SERVICES: BREAKING DOWN BARRIERS TO ASSIST CLIENTS IN ACCESSING PUBLIC BENEFITS Both government agencies and private organizations have developed webbased services that social workers can use to break down barriers to clients accessing public benefits. Table 1 provides links to three important federal government public websites. First, benefits.gov provides information on approximately 1,000 federal and state benefits. After eligibility screening, users are given a list of benefits for which they might be eligible and information on application procedures. This site also provides a “community advocates” link, which social workers can use to locate government benefits for clients. Because the “digital divide” continues (Garson, 2006), this type of service is particularly important. That is, clients with low incomes who are more likely to be eligible for public benefits are among those who are less likely to have computers and Internet access. Second, the USA.gov site provides links to 47 million federal government web pages and links state, local, and tribal government web pages that provide information on (and ways to apply for) public benefits (Garson, 2006). The third example is the “SNAP Pre-Screening Tool,” which assists the public in applying for food stamps. All states provide public access to online public benefits information and online access to application forms for at least one public benefit (Wright, 2007). Although examples of state websites in Table 1 also provide methods for eligibility screening and for estimating the value of the benefits, these websites and related reviews indicate variability in the services (Schott & Parrott, 2005; Wright, 2007). These services offer an eligibility screening process (e.g., use of a calculator versus fill-in forms); choice of languages; use of electronic signatures; the ability to submit and track applications online; and training and resources provided to staff in community-based organizations (CBOs). Table 1 also shows that only a few government websites (such as California and Florida) provide CBO training and additional assistance.

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Federal Government GovBenefits.gov: official U.S. government’s benefits website http://www.benefits.gov USA.gov: official U.S. government’s web portal http://www.usa.gov SNAP Pre-screening Eligibility Tool http://www.snap-step1.usda.gov/fns State Governments California Healthy Families Program http://www.dhs.ca.gov/health-e-app Department of Social Services http://www.cdss.ca.gov/cdssweb/PG190.htm Limited to approved agencies http://www.healthyfamilies.ca.gov/EEs_CAAs/Health-e-app. aspx Commonwealth of Pennsylvania Application for Social Services (COMPASS) https://www.humanservices.state.pa.us/compass/CMHOM. aspx Florida (ACCESS) http://www.myflorida.com/accessflorida

Website

Varies by linked webpage Varies by linked webpage

Yes

Submission for health insurance programs only with assistance

9 types of benefits and assistance

SNAP, cash assistance, Medicaid

Yes

Yes

Yes

Yes

Varies by linked webpage

Online application submission

Yes

Public access

Extensive, multiple areas

Brief training if requested

Online training

None

None

None

CBO∗ training

TABLE 1 Examples of Federal and State Government Web-Based Services That Assist Families in Accessing Public Benefits

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Tracks applications and generates reports Community partners allowed access to case information

Tracks applications and generates reports

None

“Community Advocates” link None

CBO∗ resources and services

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SNAP None Cash, food, medical, child care SNAP, health insurance

Yes Yes Yes

Yes

Health insurance, SNAP, TANF

None

Yes

Yes

None

Yes

None

Online training

None

None

None

None

None

Community partners assist clients None

None

None

None

None

None

Note: All websites, either on their own or through links with other government websites, provide information on public benefits, application procedures, methods to screen eligibility and estimate public benefits, and provide applications that can be downloaded or completed online. Many of these websites provide information and screening for other types of government and private assistance. Information was obtained from inspection of the websites. ∗ Community-based organizations.

Texas (State of Texas Assistance and Referral System [STARS]) https://www.yourtexasbenefits.com/wps/portal

Mississippi http://www.mdhs.state.ms.us New Mexico http://www.hsd.state.nm.us/isd/apply.html New York (myBenefits) https://www.mybenefits.ny.gov/selfservice North Dakota http://www.nd.gov/dhs/services/financialhelp/index.html Washington State http://www.dshs.wa.gov/onlinecso/applying.shtml Wisconsin (ACCESS) https://access.wisconsin.gov

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Many private organizations also sponsor websites to assist the public in applying for public benefits and aid staff in CBOs to help clients qualify. As indicated in Table 2 these websites vary to a greater extent than government-sponsored ones with respect to access to the services, whether applications can be submitted online, the training and services provided to CBO staff, and fees charged. For example, the Benefit Screener and the Milwaukee Workers Web Site offer all of their services applicable to the public, while other websites, such as the Benefit Bank, Benefits Checkup, and Bridge to Benefits, also provide additional services to CBOs. However, Benefits Checkup charges a fee for these services. Finally, some web-based services, such as HelpEngen and NH Par Tech, allow access to their web-based services only to CBOs and usually charge fees. In exchange for these fees, enhanced training, ongoing support, and software functions are provided that are not available from most public and privately sponsored sites. For example, the software provided by HelpEngen (formerly RealBenefits) provides household information to simultaneously screen for eligibility for multiple public benefits, then uses that information to complete applications for the determined eligible programs and submits the application electronically if the state offers such an option (McKean, 2006).

Reducing Participation Barriers Web-based services available to the public and to CBO staff can break down access barriers that deter households from applying for public benefits. Examination of content on the websites presented in Tables 1 and 2 indicates that such services can decrease information costs. To investigate this barrier reduction, survey interviews were conducted among 44 Chicagoarea community agencies (with different levels of HelpEngen usage) and with 70 clients who had received benefits after staff had used the web-based service (McKean, 2006). Staff generally agreed that the training increased their knowledge of public benefits and eligibility guidelines. In addition, the majority (72.6%) of the interviewed clients who were assisted in applying for public benefits learned of their potential eligibility through one of the agencies. Web-based services also can reduce a variety of administrative barriers to applying for public benefits. Because publicly available websites can be accessed at any time and location, the services offer greater flexibility and convenience. After eligibility screening, web-based services frequently provide applications that can be downloaded or filled out online, and the applications then can be submitted electronically, mailed, faxed, or taken to the appropriate agency for processing. Surveys confirm that clients and staff believe that applying for public benefits using this “one-stop shopping approach” is easier, less time consuming, more convenient, and preferable to

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Arizona Self Help http://www.arizonaselfhelp.org Arizona Community Action Association The Benefit Bank www.thebenefitbank.com Solutions for Progress, Inc. Used in AK, DC, FL, KS, MD, MS, OH, and PA The Benefit Screener http://www.massresources.org Community Resources Information, Inc. Used in MA BenefitsCheckup National Council on Aging www.benefitscheckup.org All 50 states and DC for persons age 55+ Bridge to Benefits Children’s Defense Fund of MN and Rural Dynamics, Inc. http://www.bridgetobenefits.org/ Used in MN, MT, ND, and SD EarnBenefits (developed by Seedco) www.EarnBenefits.org Used in NY, TN, GA, MD, KY

Website

Varies by benefit

Varies by state and benefit

No

Yes

Yes

Yes

Varies by state and benefit

Varies by state and benefit

Yes

Limited

No

Online application submission

Yes

Public access

Comprehensive training, help desk

Online power point, customer support

Online videos, customer support

None

Comprehensive hands-on training, help desk

None

CBO∗ training

No Tracks clients screened and eligible, and downloadable brochure Streamlines eligibility screening and tracks applications

(Continued)

Yes

Yes

No

No

No

CBO∗ fee

Tracks applications and generates reports

Downloadable brochure, and newsletter

Access to software materials to help promote service

None

CBO∗ resources and services

TABLE 2 Examples of Privately Sponsored Web-Based Services That Assist Families in Accessing Public Benefits

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Varies by state and benefit

No

Varies by benefit No

Yes

No

No

Online application submission

No

Public access

Hands-on training, help desk

Online tutorials, help desk

None

Hands-on training, help desk

CBO∗ training

Referral routing, tracking, and generates reports Produces household budgets, assists clients to enter and stay in the workforce

Streamlines eligibility screening, tracks applications, and generates reports None

CBO∗ resources and services

No

Yes

No

Yes

CBO∗ fee

Note: In addition to the CBO resources indicated, services for CBOs include information on public benefits, application procedures, methods to screen eligibility for and to estimate public benefits, and with the exception of the Self-Sufficiency Calculator, some applications that can be downloaded or completed online. Many of these websites provide information and screening for other types of government and private assistance. Information was obtained from inspection of the websites. ∗ Community-based organizations. a At the time of the study, this website provided access to information on public benefits, but this service no longer exists. b At the time of the study, this website was accessible, but no longer exists.

HelpEngen (formerly RealBenefits) TriHealix, Inc. http://www.helpengen.com/te/index.jsp Used in ME, MA, IL Milwaukee Workers Web Sitea New Hope Project and the University of Wisconsin-Milwaukee http://www. milwaukeeworkers.org NH Par Techb http://www.nhpartech.org/aboutus.html Used in NH Self-Sufficiency Calculator Women’s Center for Education and Career Advancement http://www.wceca.org Used in New York City

Website

TABLE 2 (Continued)

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applying directly at a government office (McKean, 2006). Furthermore, use of web-based services can reduce administrative costs and increase client access, particularly for those who may have difficulty making office appointments due to illness, disability, age, work, lack of child care, or transportation (Graf & Ik-Cho, 2004; Summit Consulting Collaborative, 2008). Web-based services also can address language barriers, as options to English are provided on most websites, and community agency staff with fluency in relevant languages can assist clients with limited English proficiency. Research also indicates that web-based applications are processed more quickly than paper applications (Summit Consulting Collaborative, 2007; Wright, 2007); hence, households should obtain their benefits sooner. Finally, web-based services can reduce the social and psychological costs of applying for public benefits. Because these modalities allow clients to learn about and apply for public benefits in a confidential setting, the stigma and reluctance clients may experience when applying for the benefits can be mitigated (Heartland Alliance, 2004). In addition, using a web-based calculator to determine likely eligibility for (and the prospective amount of) the benefits can reduce reluctance to apply based on perceptions of the amount of paperwork and time involved, immigrant status, and fear of mistreatment at government offices (Summit Consulting Collaborative, 2008). A recent survey confirms that the overwhelming majority of staff and clients believe that agency web-based assistance substantially reduces clients’ reluctance to apply for entitlements, and enhances their feelings of trust and comfort (McKean, 2006). Using a web-based service in community agencies also appears to be particularly helpful for clients with mental health conditions and a previous denial of benefits (McKean, 2006).

Social Work Education Applications In this section, we will apply the previous discussion and findings to social work education. First, students must understand the importance of assessing whether their clients have adequate income to meet basic needs or are experiencing material hardship (e.g., living in inadequate housing, unable to pay basic bills, eating inadequate food, or accessing needed medical and dental care). This goal can be achieved by presenting lectures on the previous content, demonstrating that living in poverty is a common life event; that economic and material hardships are harmful; that assisting clients in accessing public benefits can provide therapeutic benefits; that many eligible households currently fail to receive such benefits because of systemic barriers; and that assessing economic hardship and assisting clients in receiving needed benefits are consistent with social work values and thus the program’s educational expectations. Additional strategies would include providing case scenarios, using a poverty simulation (Vandsburger & Duncan-Daston, 2010), and developing a service learning project in conjunction with community

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agencies wherein students would assist clients with accessing public benefits using web-based services. All of these activities can increase students’ sensitivity to a life in poverty, the consequences of economic hardship, and the importance of public entitlements. Second, as research suggests (Krumer-Nevo & Lev-Wiesel, 2005), social workers’ reluctance to help clients acquire basic benefits may primarily be due to a lack of efficient strategies for assisting clients in locating relevant resources. Increasing students’ awareness of the web-based services presented in Tables 1 and 2 may serve significantly to overcome reluctance to engage in these activities. Third, as Fitch (2005) suggests, one way to enhance the use of information technology in the human services is to teach students how to use the relevant technology in class. Instructors can give assignments that require students to locate, examine, and use web-based services that can assist clients in learning about and applying for public benefits. An in-class exercise might include role-playing a session in which a social worker helps a client to learn about and access public benefits, using several scenarios. For some “clients,” students could briefly provide information on and demonstrate the web-based service, and the client could determine eligibility and apply for relevant public benefits after the session. However, because of the previously discussed “digital divide,” the students will need to assess whether the client has a computer, Internet access, and computer skills. When the latter are lacking, one could either use the web-based service during session or make provision for the necessary skills and resources. For example, community computers with Internet access could be located and, if computer skills are lacking, training could be offered. Fourth, Fitch (2005) also suggests that if social work students are going to adopt information technology, the instructor must teach the relative advantages of the technology compared with manual methods. Teaching the ways in which web-based services break down barriers to clients’ accessing public benefits is consistent with this suggestion. Instructors also can model the use of web-based services and divide students into groups to discuss both the inherent barriers and advantages. Fifth, in addition to understanding how web-based services can reduce the stigma of applying for public benefits, students may want additional strategies for assisting clients in overcoming such stigma. Faculty, for example, can teach students to provide clients with evidence that contradicts media portrayals and public perceptions that public benefits recipients have little in common with the average American. Research shows that approximately two-thirds of all adults in America receive some form of public assistance at least once during adulthood, and 60% receive public assistance for less than 5 years (Rank, 2005). Receipt of public benefits can be reframed from dependency and a source of stigma to receipt of an insurance against economic hardship.

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Sixth, students will need to be aware of barriers that might prevent them from using web-based services to assist clients in accessing public benefits and offered ways to reduce such barriers. For example, some social workers might need significant information technology and administrative support for engaging in such activity. This possibility was confirmed by Weiss-Gal and Gal’s (2009) study, which found a correlation between social workers assisting clients in accessing public benefits and perceptions of the need for organizational support for such activity. Staff serving immigrant populations also may need additional training in cultural competence and the use of multilingual materials (McKean, 2006). Although screening clients’ eligibility and assisting them in filling out applications are not particularly time consuming (e.g., an average of 24 minutes for the HelpEngen software [McKean, 2006]), an additional constraint may be the time required to assist clients in completing the application process when the applications and/or verifying documents cannot be submitted online (Graf & Ik-Cho, 2004). Instructors might elicit such barriers from students and implement a problem-solving exercise to identify effective ways to reduce them. Finally, teaching the previous knowledge by using appropriate instructional methods may have the added benefit of increasing students’ interests in public welfare and social policy, which frequently is lower than their practice courses (Dichter & Cnaan, 2010), and assisting students in making the connection between social policy and micro–social work practice. Moreover, if they regularly assist clients in accessing public benefits, students likely will become aware of the limitations of public benefits programs in helping clients meet their basic needs. Such awareness may enhance students’ motivation to actively engage in advocacy and the promotion of progressive social change.

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