摘要：Objectives . This study evaluated the association of chronic child illness with parental employment among individuals who have had contact with the welfare system. Methods . Parents of children with chronic illnesses were interviewed. Results . Current and former welfare recipients and welfare applicants were more likely than those with no contact with the welfare system to report that their children’s illnesses adversely affected their employment. Logistic regression analyses showed that current and former receipt of welfare, pending welfare application, and high rates of child health care use were predictors of unemployment. Conclusions . Welfare recipients and applicants with chronically ill children face substantial barriers to employment, including high child health care use rates and missed work. The welfare reform reauthorization scheduled to occur later in 2002 should address the implications of chronic child illness for parental employment. The 1996 Personal Responsibility and Work Opportunity Reconciliation Act significantly changed welfare policy in the United States. The stated intent of the legislation, commonly referred to as welfare reform, was to decrease reliance on welfare and increase the economic independence of poor families. The legislation replaced the Aid to Families with Dependent Children (AFDC) program with the Temporary Assistance for Needy Families (TANF) program, eliminated entitlements to cash benefits, and imposed a 5-year time limit for benefits, work requirements, and benefit reductions or terminations for noncompliance with program provisions. 1 Parents of children with chronic conditions are likely to experience difficulties complying with these new requirements because their children’s health needs require them to take so much time away from work. Low-income parents in general, and current and former welfare recipients in particular, are more likely to have low-wage jobs that do not provide vacation or sick leave that would allow them to care for sick children. 2– 5 Welfare recipients have been shown to cite child illness as a barrier to employment. 1, 6– 9 Anything that poses a barrier to sustained parental employment, such as chronic child illness, will undermine the intent of the welfare legislation. The law has incompletely addressed the needs of families with chronically ill children, however. Welfare agency screening for health barriers to employment is often inadequate. 10 In addition, welfare recipients with chronically ill children are often unaware that work exemptions and time limit extensions based on child illness are available. 11 Because those targeted by the legislation are parents, understanding the implications of chronic child illness for parental employment will be important when the legislation is reauthorized later in 2002, especially given current proposals to increase the work requirement. 12 There has been no research since the implementation of the welfare reform legislation that has specifically considered the association of clinically significant rates of chronic child illness with particular employment outcomes among parents who have had contact with the welfare system. In the present study, we sought to fill this gap by exploring the prevalence of employment barriers among a cohort of families with chronically ill children.
