Systems of Care: Yu-Ling Chang and Emmeline Chuang analyze the social safety net

woman holding child as she reaches for supermarket produce
May 14, 2022

The COVID-19 pandemic has highlighted inequity on many levels, and came as a stark reminder that economic vulnerability is a structural problem rather than an individual one.

The scholarship of assistant professor Yu-Ling Chang and associate professor and Mack Center director Emmeline Chuang examines the effectiveness of U.S. social safety net programs for the populations they are intended to serve. Meanwhile, Dr. Sarah Carnochan's work with the Bay Area Social Services Consortium (BASSC) helps strengthen systems of care within the Bay Area and California. Their work stands to inform policy on a statewide and national level.

Yu-Ling Chang's research focuses on assessment of social safety net programs through the lens of immigration status, gender, race, and other measures of equity. Prior to joining Berkeley Social Welfare in 2016, she earned her PhD in social welfare from the University of Washington, with a concentration in public policy and management.

In a recent article, "Examining low-income single-mother families' experiences with family benefit packages during and after the Great Recession in the United States" (Journal of Risk and Financial Management), Chang and co-author Chi-Fang Wu shed light on the limitations of the current work-based safety net system for economically vulnerable families.

Chang's study examined the interplay of employment and seven social safety programs in the economic lives of low-income single mothers during the Great Recession and its recovery period. The study analyzed employment trajectories over time, comparing patterns of benefits usage among single mothers who were stably employed, stably unemployed, or who alternated periods of employment and unemployment. Employment patterns and benefits usage were cross-tabulated with sociodemographic characteristics like citizenship status, race, educational attainment, and family composition. Her findings highlighted that the majority of low-income single mothers were not stably employed, nor did they achieve economic sufficiency. Many of them were patching together benefits but were rarely using all of the eligible programs at any given time.

Chang's analysis reveals that single-mother families rely more frequently on in-kind basic needs benefits like Medicaid and the Supplemental Nutrition Assistance Program (SNAP). Since cash benefits like Unemployment Insurance (UI) and Temporary Assistance to Needy Families (TANF) are tied to stable employment record and sufficient working hours respectively, they fundamentally disadvantage single mothers, who frequently shoulder both earning and caregiving responsibilities and are more likely to hold low-paying, unstable jobs.

By examining actual patterns of benefits use over time, Chang's analysis advances the understanding of how well safety net programs serve their target populations. She highlights the need for a predictable basic benefits package, one that includes cash assistance even — and especially — when a client does not meet employment criteria.

Another 2021 article examines benefits use by immigrant families, particularly in California. "At the intersection of immigration and welfare governance in the United States: State, county and frontline levels and clients' perspective" was authored by former postdoc Lucia Lanfranconi, Chang, and Ayda Basaran and published in Zeitschrift für Sozialreform. With one in four California residents born outside the U.S. and 46% of California children living in immigrant families, California has the nation's largest immigrant population. It also has the most inclusive benefits policies, using state funding to expand TANF, SNAP, and Medicaid to immigrants who would otherwise be ineligible due to their immigration status.

Even so, California's public benefits programs underserve immigrant families living in poverty. This study explores the experiences of immigrants with TANF. Of the 1.6 million children living in poverty in California, 55% live in immigrant families. 90% of participants in CalWORKS (California's iteration of TANF) are citizens; only 10% are noncitizens.

Some of this disparity is due to hesitation among immigrants to be perceived as a public charge: interviews revealed widespread fear of violating the public charge rule, with the result that many families would rather live in poverty than receive public benefits.

In other instances, though, the disparities were related to procedural and language obstacles. In a comparison between two counties, the study found considerable variation in practices with respect to translation, culturally adapted materials, and outreach. They also observed variation in county workers' understanding of current policy. Chang and her co-authors highlight how discretionary practices at the county level can influence a program's inclusion. As with the analysis of benefits usage by single mothers, they stress clients' lived experience as a metric of program effectiveness.

In 2020, Chang was awarded a prestigious Family Self-Sufficiency and Stability Research Scholars Network Grant from the Administration for Children and Families in the federal Department of Health and Human Services. Her project aims to examine study racial equity in the implementation of CalWORKS in partnership with the California Department of Social Services (CDSS) and the California Policy Lab.

While the study launch was delayed by pandemic-related challenges, Chang is currently examining client-level longitudinal data. Preliminary analysis is starting to reveal a more nuanced understanding of racial disparities in CalWORKS. Previous studies had revealed that Black and Hispanic clients were more likely to be sanctioned for noncompliance with the program's work requirements; Chang's early analysis of the data indicates that Asian American and Pacific Islander clients were also more likely to be sanctioned. However, since close to 50% of the sample data does not contain information about sanctions, she will also examine whether the missing data patterns are evenly distributed by race. Even though the study is still in the data cleaning stage, Chang is confident that the study will yield good insights — for both the state and federal government — around equitable approaches to TANF.

As one of five grant recipients nationwide, Chang will also collaborate with her fellow PIs to share insights over the 60-month grant term, contributing to a greater understanding of variations in TANF implementation from state to state.

Dr. Chang is also expanding her research scope from cross-state comparative research in the US to comparative research in a global context. She is engaged in collaborations with scholars in Japan, Korea, Taiwan, Hong Kong, and China in examining in-work poverty, social safety nets, and their response to crises. Since East Asian countries are frequently marginalized in social welfare research, these collaborations stand to bring an important perspective to the field.

Throughout her scholarship, Chang is an advocate for inclusive systems and for a shift away from the rhetoric of "deserving" and "undeserving" poor."I believe social work students and scholars need to help shift the narratives," she says. "We are the profession closest to vulnerable populations, so we need to speak out for them and encourage them to speak out on behalf of their communities."

Associate Professor Emmeline Chuang joined Berkeley Social Welfare in January 2020. Her research focuses on how the nature and quality of inter-organizational relationships between health and human service organizations affects service access and client outcomes, and how the design of work affects provider and staff satisfaction and quality of care.

Much of Chuang's research focuses on programs within California, where her work has statewide impact. One recent large-scale project, in collaboration with her former colleague Nadereh Pourat of UCLA, examines the implementation of Whole Person Care, a Medicaid Section 1115(a) waiver demonstration project. Launched in 2016, the WPC Pilot Program aimed to promote the integrated delivery of care for Medi-Cal beneficiaries who are high utilizers of multiple publicly funded service systems. Because these clients typically have complex medical, social, and behavioral needs, WPC beneficiaries receive care coordination, housing assistance, and other services not traditionally covered by Medi-Cal.

Chuang and Pourat published preliminary findings in a 2020 Health Affairs article, "Integrating Health and Human Services in California's Whole Person Care Medicaid 1115 Waiver Demonstration." Their analysis found significant progress in developing partnerships, data-sharing infrastructure, and services needed to coordinate care. They highlighted success factors like relationship-based outreach to clients. The study also identified barriers, including the resource-intensiveness of identifying and engaging eligible beneficiaries as well as the lack of affordable housing.

In an April 2020 blog post on the Health Affairs website, Chuang and Pourat concluded that the data sharing infrastructure and partnerships developed for WPC helped with counties' COVID-19 response efforts. Newly developed or strengthened relationships between medical, behavioral health, and social service providers helped improve outreach to vulnerable populations and distribution of personal protective equipment, and data-sharing infrastructure were used to identify individuals at highest risk of COVID-19, monitor COVID-19 cases, and help monitor local hospital and clinic capacity. Chuang and Pourat were subsequently awarded a grant from the Robert Wood Johnson Foundation to study the impact of the pandemic on WPC.

In a January 2022 policy brief funded by the California Department of Health Care Services, "Whole Person Care Program Successfully Navigated Around COVID-19 Challenges in 2020," they examined the longer-term effects of the pandemic on WPC. An additional policy brief, "A Snapshot of California's Whole Person Care Pilot Program: Implementation Strategies and Enrollees," examines county-by-county variations in WPC implementation.

All of these studies will help inform implementation of the new Enhanced Care Management and Community Supports benefits within CalAIM, which also aim to provide supports to address Medi-Cal enrollees' clinical and non-clinical needs.

Dr. Chuang also leads the Mack Center on Nonprofit and Public Sector Management in the Human Services, which conducts applied research on strengthening health and social safety net organizations that care for vulnerable populations. The Mack Center collaborates closely with the Bay Area Social Services Consortium (BASSC), directed by Dr. Sarah Carnochan and also based in the School of Social Welfare. BASSC is a regional consortium of 12 county human service agencies, and five University-based social work/social welfare programs.

BASSC has long served as a resource for local agencies, engaging in partnered research, providing workforce development programs, and supporting cross-county policy groups.

Chuang stresses the vital role of county social services. "These organizations are trying to do a heavy lift with constrained resources, both in terms of funding and from a staffing perspective. The county directors that the Mack Center and BASSC work with are a critical part of the social safety net."

For example, in California, older adults are the fastest-growing segment of the state's population, projected to reach 25% by 2040. County Adult & Aging Services departments play a critical role in ensuring that older adults, particularly those who are disabled or low-income, receive services and supports needed to remain safely in the home or community for as long as possible. In 2021, at the request of the BASSC Adult Services committee (ASC) and in response to a growing national shortage of care workers, the Mack Center and BASSC benchmarked wages for direct care workers and professional staff, examined the race-ethnicity of different components of the AAS workforce, and shared analyses with BASSC ASC directors.

The Mack Center and BASSC subsequently developed a statewide survey to better understand the workforce needs of Adult Social Services programs in California, partnering with the California County Welfare Directors Association (CWDA) on survey dissemination. The survey garnered a 90% response rate, with 52 of 58 counties responding. The resulting California Adult Social Services Workforce Report — whose co-authors include Chuang, Carnochan, and E. Maxwell Davis — provides a broad overview of adult social services statewide, benchmarks current staffing policies and practices, and DEI efforts. The report also identifies recruitment and retention challenges, such as limited promotion opportunities, pay inequities for staff, and difficulty recruiting workers fluent in the languages spoken by the clients being served.

For Chuang, tracking this information provides an important metric for building more inclusive systems of care. "When the workforce isn't representative of the clients being served," she asks, "what does that mean for the trust and engagement that vulnerable populations may have in the systems that are trying to provide care?"

In 2022, the Mack Center and BASSC also began to work closely on a facilitated strategic planning process for the BASSC ASC, in part to help align regional workforce development and advocacy efforts with the state's new Master Plan on Aging.

By identifying successes and areas for improvement in policy implementation, the work of Drs. Chang, Chuang,and Carnochan helps build systems that meet the needs of the populations they serve, meet the needs of frontline workers, and make efficient use of public resources.

Yu-Ling Chang

Dr. Yu-Ling Chang

Dr. Emmeline Chuang

Dr. Emmeline Chuang

Sarah Carnochan

Dr. Sarah Carnochan