How recession-proof are PHN interventions? Recession exposure, health, and employment outcome findings from a recent RCT

Background: The high prevalence of health conditions among women receiving Temporary Assistance for Needy Families (TANF, or ‘welfare') impedes the ability of this group to move from ‘welfare-to-work', and the economic recession has likely exacerbated this problem. Despite this, few studies have tested interventions to improve health outcomes for women receiving TANF, and it remains unclear how the recession has influenced employment in this group.

Methods: We tested a public health nursing (PHN) intervention with 432 women who were receiving TANF and had one or more chronic health conditions using a randomized controlled trial (RCT) design. We report on four employment outcomes by group assignment and recession exposure, and examined whether select baseline sociodemographic and health characteristics predicted employment. The Kaplan-Meier method, a zero-inflated negative binomial model, and general linear model were used to analyze data.

Results: Women in the intervention group were marginally more likely to become employed (p=0.05), and there were significant main effects for median time-to-employment by group assignment (intervention and control group: 72 vs. 107 days, p=0.01) and recession exposure (no and full exposure: 70 vs. 122 days, p<0.001). Age, education, race, and functional status at baseline predicted different dimensions of employment over the 9 month study period.

Conclusions: These findings have direct policy relevance for understanding health and employment dynamics among this group of highly disadvantaged women. A public health nursing case-management intervention to improve employment outcomes was equally effective among this group under highly variable macroeconomic conditions.