Increasing understanding of the factors influencing access ... · Increasing understanding of the...

35
Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals and families living in poverty in the St. Louis area A report to the Jewish Federation of St. Louis October, 2018 Elizabeth A. Baker, PhD, MPH Keon L. Gilbert, DrPH, MA, MPA

Transcript of Increasing understanding of the factors influencing access ... · Increasing understanding of the...

Page 1: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

IncreasingunderstandingofthefactorsinfluencingaccesstoandutilizationofservicesamongJewishindividualsandfamilieslivinginpovertyintheSt.Louisarea

AreporttotheJewishFederationofSt.Louis

October,2018

ElizabethA.Baker,PhD,MPHKeonL.Gilbert,DrPH,MA,MPA

Page 2: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

2

ExecutiveSummary

In-depthindividualinterviewsandsurveyswereconductedwithserviceproviders(19)andindividuals/familiesintheJewishCommunitywhohaveusedservices(10).Providersindicatedthatthefourfactorsthatmayinfluenceconsumers’useofservicesarecost,stigma,familyobligationsandtransportation.Theyalsoindicatedthatthatfood,mentalhealthandchild-careserviceswerethemostutilizedservices.Eldercareserviceswereamongthosethatweretheleastutilized.Servicesthatprovidersindicatedwerethemostwell-fundedwerecontinuingeducation,foodandmentalhealthservices.Housingrepair,substanceuse,andhousingaccesswereidentifiedastheleastwell-funded.Providersalsoindicatedthatwhileallservicescouldbenefitfromadditionalfundingandresourceallocation,food,eldercare,childcare,employment,andmentalhealthservicesweremostinneedofadditionalfunding.Oftheservicesweaskedprovidersabout,employment,childcare,housingrepair,mentalhealth,foodandhealthcareserviceswerementionedasbeingamongthegreatestneeds.Someprovidersalsoindicatedthatthereweresomeotherneedsthatcouldbeaddressedforyouthsuchasorthodontics,music,art,dance,andsports.Theaverageageofconsumerswhocompletedthequestionnairewas53,witharangeofagesbetween42and73.Fiftypercentofparticipantsdescribedthemselvesas“unabletomakeendsmeet,”andtheremaininghalfofparticipantsdescribedtheirhouseholdfinancialsituationas“justmanagingtomakeendsmeet.”Theparticipantswereprimarilyfemale(87.5%).Intermsofeducation,themajorityofparticipantshadanAssociatedegreeorsomecollegeexperience(66.67%).Themajorityofparticipantswerereform(62.5%)withallother“denominations”beingrepresentedby12.5%ofrespondents(orthodox,conservative,non-denominationaland“JustJewish”).Themajority(75%)ofparticipantsindicatedthatbeingJewishwasveryorsomewhatimportanttothem.WhilethissampledoesnotrepresentthecompletediversityoftheJewishpopulationexperiencingpovertyintheSt.Louisarea,thequalitativeandquantitativedataprovideddoessuggestsomeconsistentconcernsandpresentsomecompellingopportunitiesforimprovingservicestoenhanceaccessandutilization. Fiftypercentormoreofconsumersindicatedthatthefollowingwerealways,often,orsometimesafactorinfluencingutilizationofservices:cost,stigma,agencyisJewishaffiliated,healthstatusandtransportation.Whenaskedabouthowlikelytheyweretouseavarietyofservices,overathirdoftheconsumersindicatedthattheywereverylikelytousethefollowing:housingrepair,employment,continuingeducation,mentalhealth,foodandhealthcare.Itshouldbenotedthattheneedforsomeservicesmayhavebeendifferentinoursamplethantheoverallpopulationinneedbecauseofavarietyoffactorssuchasagedistributionorchildreninthehousehold.

Thequalitativeinterviewswithbothprovidersandconsumersidentifiedanumberoffactorsthatwereidentifiedasinfluencingaccesstoandutilizationofservicesattheindividual,social/cultural,organizational,interorganizationalandenvironmental/contextuallevels.

Intermsofindividuallevelfactorsthoseinterviewedindicatedthatthereisalackofinformationaboutservicesprovidedandtheeligibilityrequirementsforusingtheservices.Theyalsoindicatedthattherewasagreatdealofbureaucracyinaccessingservices.Respondentsalsoindicatedthatconsumersoftendo

Page 3: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

3

notwanttosharepersonalinformation.Therewereconcernsraisedaboutstigmaimposedbystructuresandindividualsandembarrassmentregardinguseofservicesaswellasfearaboutwhathappensiftheiruseofservicesisdiscoveredbyothers.Therewereconcernsraisedaboutstigmathattheyidentifiedasbeingcreatedbythestructuresofaccessingcarenotonlyafunctionofindividualbeliefs.

Intermsofsocial/culturalfactors,concernswereexpressedthatsomeprovidersmaynotbesensitivetotheuniqueneedsofJewishfamiliesandsomearticulatedalackofunderstandingofthedifferentneedsamongdenominationswithintheJewishcommunity.ThoseinterviewedalsoexpressedconcernsthatparticipatinginJewishcommunallifeisexpensive,puttingfamiliesinapositionwheretheyneedtorequestassistancebutdonotmeetmosteligibilityrequirementsforservices.Itwasalsonotedthattheimportanceofthereligiousaffiliationoftheserviceagencyorspecificprovidervariesconsiderablyandtoalargeextentdependsonthetypesofservicesneeded.Inotherwords,religiousaffiliationislikelytomattermoreforthingslikefoodandmentalhealth,andlessforthingslikehousingandcarrepair.

Intermsoforganizationalfactors,thoseinterviewedvoicedconcernsaboutunclearcriteriaforutilizationofservices,aswellasbureaucracyandrestrictionsonhowresourcescanbeused.Thoseinterviewedalsopointedtoconcernsaboutinsufficientservices,inconvenienthoursofservice,limitedlocationsandservicemodels.TherewerealsoconcernsthattheservicesprovidedwithintheJewishcommunityareinferior.Inpart,thiswasattributedtostaffturnover,andstaffnotknowingaboutserviceswithintheirownagencies.

Intermsofinterorganizationalfactors,thoseinterviewednotedthatJewishagenciesoftendon’treferindividualsorfamiliestoeachother.Thiswasidentifiedasbeinginpartduetothefactthattheyareunawareofwhatotherorganizationsoffer.Theyalsonotedthesignificantproblemscausedbyinteragencysilos.Inparticularthoseinterviewedvoicedtheneedforinteragencyagreementstoeasetheuseofservices,andthesharingofcaseinformationtoreducetheburdenonfamilies. TheyalsohighlightedtheneedforJewishandnon-Jewishagenciestocreatewaystoshareinformationaboutservicesandworkmorecollaboratively.

Inconsideringcontextualfactors,theoneissuethatwasnotedrepeatedlywaschallengeswithtransportation.Thoseinterviewedalsonotedthatthereisageneralneedforadditionalservices,particularlymentalhealthservices,homeimprovement,andnecessitiesbeyondfood(e.g.,toiletpaper,toothpaste).

Basedonourfindings,thereisnotonesinglebestapproachforimprovingservicestoJewishindividualsandfamilieslivinginpovertyintheSt.Louisarea.Ratherthemostimportantchangesmaybedifferentdependingonthecircumstance,theindividual,andtheirdenomination.However,bothprovidersandconsumershadsomekey,andconsistent,recommendations.Someoftheserecommendationsarethedirectextensionofchallengesthatwerehighlighted(e.g.,peopledon’tknowaboutservices),whileothersarestrategiesidentifiedbythoseinterviewed(e.g.,tellpeopleinthecommunityaboutservicesthroughprintmedia,socialmedia,orinperson).Morespecifically,thedatasuggestthatinordertoimproveaccesstoandutilizationofservicestheFederationneedsto1)improvemarketing/communicationtoincreaseawarenessofandinformationaboutservices,2)establishformalnetworksandcollaborationamongserviceproviders,3)createopportunitiesforprovidingon-going,confidentialfeedbackonhowtoimproveservices,and4)createalternativeserviceprovisionmodels.

Page 4: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

4

TableofContents

Background Page5

PuttingtheexperienceofpovertywithinSt.Louisintoalocalandnationalcontext

Page6

Factorsinfluencingaccesstoandutilizationofservices

Page10

OpportunitiesforactionandreflectionAppendix:Surveyinstruments

Page19Page22

Page 5: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

5

Background

OneoftheJewishFederation’sgreatestprioritiesistobuildahumanservicesafetynettoidentify,monitor,andcareforthemostvulnerableandisolatedmembersoftheJewishcommunity.In2014theFederationconductedastudythatfoundthatpovertyandhungerintheJewishcommunitywashigherthananticipated,with26%oftheJewishcommunityintheSt.Louisareaconsideredpoorornearpoor.Thestudyalsofoundseveralbarrierstoserviceutilizationamongthispopulation.TheirsubsequentPovertySummitinFebruaryof2016foundthatthereweremanygapstoservicesincluding:

• Lackofknowledgeaboutbenefitsandresourcesaswellasaccesschallenges–individualsdonotknowwhatprogramsareavailablefromtheJewish,publicandsecularorganizations,andmayneedassistancecompletingcomplicatedapplicationprocesses.

• Multiplepointsofentrywithlittlecoordination–thereisnocommoninformation,intake,andreferralsystemtoaccessavailableresources.Peopleinneedhavetoseekassistanceseparatelyfromnumerousorganizations,eachwithdifferingrequirementsandapplicationrequirements.

• Needforvocationalretrainingandotheremploymentprograms–individuals,especiallyBaby

Boomers,havelostjobsorbusinessesandneedhelptoidentifyandpursuealternatecareerpaths.

• Perceivedstigmaofaskingforhelp–individualsintheJewishcommunityarenotusedtoasking

forhelpandfeelembarrassedorashamed,especiallyiftheyconsiderthemselvestobedonorstocharitablecausesandnotrecipientsofhelp.

Thisreportpresentsthefindingsfromastudythatbuiltontheseinitialfindings.Thestudywasconductedinthefallof2016andwinterof2017andsoughtto:

• situatetheexperienceofpovertywithinSt.Louisintoalocalandnationalcontext,• enhanceunderstandingoffactorsinfluencingaccesstoandutilizationofservices,and• developsuggestionsforspecificchangestoimprovetheservicesofferedtoJewishindividuals

andfamilieslivinginpovertyintheSt.Louisarea.

Page 6: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

6

SituatingtheexperienceofpovertywithinSt.Louisintoalocalandnationalcontext

MethodsInordertodescribepovertyintheJewishcommunity,bothlocallyandnationally,werevieweddatafromtheBermanJewishDatabank(aprojectoftheJewishFederationsofNorthAmerica,http://www.jewishdatabank.org),publishedreports,1andhaddiscussionswithJewishFederationsinothercities.BelowweprovideinformationonthedemographicandgeographicdistributionoftheJewishpoor.Wesynthesizethefindingsfromlocal,STLbasedassessmentswithassessmentsconductedbyotherJewishorganizationsincludingthoseinChicago,IL;Cincinnati,OH;Cleveland,OH;andNewYork,NY.

Results

BasedondatafromBermanJewishDatabankthenumberofJewsinMissourideclinedfrom1971(84,325)to2015(64,275)(http://www.jewishdatabank.org),withSt.LouisbeingtheonlyurbanareainMissouriwithmorethan40,000Jews(54,000).2ForcomparisonsakeitisworthnotingthesizeoftheJewishpopulationineachofthecomparisoncommunities(definedasJewishPopulationoftheJewishFederationServiceareaorCombinedStatisticalAreadependingondataavailablein2015):Chicago,IL291,800;Cincinnati,OH;Cleveland,OH85,653;andNewYork,NY1,538,0003.

1JewishPolicy&ActionResearch.2014StLouisJewishCommunityStudy.2014StLouisJewishCommunityStudy.HumanServices:Poverty,Hunger,SocialServicesandSeniors.PresentedApril20,2015.JewishFederationofStLouis.PovertySummitNotes.February10,2016Ukeles,JB(2012)Ataleoffourcities:LearningaboutJewishCommunity.Presentationpresentedatthe2012GeneralAssemblyinBaltiore,MD.2IraM.SheskinandArnoldDashefsky.“JewishPopulationintheUnitedStates,2015,”inArnoldDashefskyandIraM.Sheskin.(Editors)TheAmericanJewishYearBook,2015,Volume115(2015)(Dordrecht:Springer)pp.163-260.

3IraM.SheskinandArnoldDashefsky.“JewishPopulationintheUnitedStates,2015,”inArnoldDashefskyandIraM.Sheskin.(Editors)TheAmericanJewishYearBook,2015,Volume115(2015)(Dordrecht:Springer)pp.163-260.

Page 7: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

7

AsisevidentinTables1-3,below,thesurveysconductedineachofthesecitiesusedsomewhatdifferentsamplingmethods(e.g.,randomdigitdialingversussamplingbasedonlastname),anddefinedthevariablesintheirsurveysomewhatdifferently(e.g.,100%federalpovertyversus150%federalpoverty).Inspiteofthis,therearesomeusefulcomparisons.Forexample,inallcommunitiesthereareanumberofindividuals/familieswhoarejustmanagingand/orlivinginornearpoverty.InSt.Louis,24%ofthoseinterviewedidentifiedasjustmanagingorunabletomakeendsmeetincomparisonto,22%inCincinnati,35%inChicago41%inClevelandand42%inNY(SeeTable2).St.Louishas8%ofJewishhouseholdslivingbelow150%ofpoverty,whileChicagohas7%,Cleveland12%andNY19%.4IfonelooksatnearpoorJewishhouseholds,St.Louishas18%ofhouseholdsbeingdefinedasnearpoor(150%-250%ofFPL)whereasChicagohas4%,Clevelandhas7%(definedas150%-200%FPL)andNewYorkhas10%(150%-250%FPL).AscanbeseeninTable3,theSaintLouisJewishcommunityandtheSaintLouisCountyCaucasianpopulationappeartobemoresimilarintermsofageandincomethaneitherCaucasiansinthecityorAfricanAmericansineitherthecityorcounty.InSt.Louis,asinothercitiesacrosstheUS,Jewishfamilieslivingatornearpovertyhavefoundthemselvesseekinganumberofdifferentkindsofassistance.WithinSt.Louis,25%oftheJewishpoorand28%ofthenearpoorhaveidentifiedthemselvesasbeingfoodinsecure(cuttingthesizeoftheirmealsorskippingmealsbecausetherewasnotenoughmoneyforfood).5Thirty-sixpercentofJewishhouseholdsinSt.Louishavesoughtassistanceforatleastoneotherkindofservice(depression,housing,finances,disability,etc.).ThesechallengesinmakingendsmeetactalsoasasignificantbarriertoparticipatingJewishlife.ThosewithlowerincomesweremorelikelytoreportthatcostpreventedthemfromattendingJewishcamps,synagogues,andtheJCCinSt.Louis.ThestudiesconductedinBaltimore,ChicagoandClevelandfoundsimilarresults.6

4Ukeles,JB(2012)Ataleoffourcities:LearningaboutJewishCommunity.Presentationpresentedatthe2012GeneralAssemblyinBaltimore,MD.5JewishPolicy&ActionResearch.2014StLouisJewishCommunityStudy.6Ukeles,JB(2012)Ataleoffourcities:LearningaboutJewishCommunity.Presentationpresentedatthe2012GeneralAssemblyinBaltimore,MD.JewishPolicy&ActionResearch.2014St.LouisJewishCommunityStudy.

Page 8: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

8

Table1:Surveysamplesizes,bysamplingmethodandcity

• RDD:randomdigitdialing;DJN:distinctiveJewishnameTable2:Demographicinformationacross5cities

Year RDD* DJN List Total

SaintLouis 2014 216 30 757 1,003Chicago 2010 152 204 1,637 1,993Cincinnati 2008 228 0 684 912Cleveland 2011 114 36 894 1,044NewYorkCity 2011 3,377 451 2,165 5,993

SaintLouis(2014)

Chicago(2010)

Cincinnati(2008)

Cleveland(2011)

NewYork(2011)

#Jewishhouseholds 32,900 148,100 12,500 38,300 694,000#personsinJewishhouseholds(incl.non-Jewish) 89,300 381,900 33,000 98,300 1,769,000#persons≥65yearsinJewishhouseholds(%total)

15,806(17.7%)

67,978(17.8%)

6,100(18.5%)

17,400(17.7%)

354,000(20.0%)

#children0-5yearsbeingraisedJewish(%total)

2,000(2.2%)

19,842(5.2%)

1,360(4.1%)

4,200(4.3%)

107,274(6.1%)

Medianhouseholdincome,allJewishhouseholds $73,000 $89,000 $97,000 $73,000 $70,000Medianhouseholdincome,Jewishhouseholds≥65years $57,000 $66,000 $83,000 $53,000 $51,000

%householdsbelowFPL N/A N/A N/A N/A 10.90%%householdsreporting"justmanaging"or"cannotmakeendsmeet" 24% 35% 22% 41% 42%%respondentsreporting"fair"or"poor"health 18% 16% 13% 17% 25%

Page 9: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

9

Note:ComparisonbetweentheSaintLouisJewishcommunityandtheSaintLouisCountyCaucasianpopulationmaybemostmeaningful.Thesepopulationsarehighlightedinred.Thesedataarefromthe2015AmericanCommunitiesSurvey.Denominatorsmayvarybysurveyquestion.*Thereare17,600childreninJewishhouseholds.4,700areages0-4.**Becauseofdatalimitations,thisinformationispresentedasarange.Thedataindicatethatatleast1.9%ofJewishSt.Louishouseholdslivebelow100%FPLaccordingto2014cut-points.Thepovertystatusofanadditional4.7%ofJewishSt.Louishouseholdsmayfallintothiscategory.

Table3:ComparisonofCommunitieswithinSt.Louis Individual

slivinginJewishhousehold

Totalpopulation Caucasianpopulation African-Americanpopulation

Total County City Total County

City Total County

City

Populationsize 89,300

1,319,047

1,003,362

315,685

842,439

697,037

145,402

383,962

236,786

147,176

%male N/A 47.7% 47.4% 48.5% 48.5% 48.1% 50.5% 44.7% 44.1% 45.7%%<5years 5.3%* 6.0% 5.8% 6.7% 5.0% 4.9% 5.5% 7.1% 6.9% 7.3%%≥65years 17.7% 15.6% 16.8% 11.6% 17.7% 18.9% 12.2% 11.5% 11.5% 11.7%

%≥85years

6.0% 2.3% 2.6% 1.5% 3.1% 3.3% 1.8% 1.4% 1.3% 1.6%

%below150%FPL 8% 23.0 18.1 38.7 N/A N/A N/A N/A N/A N/A%below100%FPL N/A 14.8% 10.9% 27.1% 8.0% 6.6% 15.1 28.5% 22.4% 38.1%

Page 10: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

10

Factorsinfluencingaccesstoandutilizationofservices

MethodsIn-depthindividualinterviewswereconductedwithserviceprovidersfromJewishsocialserviceaswellassecularsocialserviceagencies(19)andindividuals/familiesintheJewishCommunitywhohaveusedservices(consumers)(12).Thoseinterviewedwerealsoaskedtocompleteaquantitativesurvey.Itshouldbenotedthatwefoundasomewhatfluidboundarybetweenthesetwocategoriesofindividuals,withsomeprovidershavingusedservicesinthepast,andsomeconsumershavingbeenprovidersinthepast.SurveyTwoquestionnairesweredeveloped.Thequestionnaireforproviderswasintendedtocapturethebreadthofservicesprovided,thepopulationsbeingserved,currentsourcesoffunding,gapsinfundingofservices,andanyadditionalneedsthatarecurrentlynotbeingmetbytheserviceagencythatrespondedorwithintheJewishCommunityatlarge.Thequestionnaireforconsumerswasintendedtocapturethefactorsinfluencingutilizationofservices,servicesthatconsumerswerelikelytoutilize,andsomebasicdemographicsinordertodescribethecharacteristicsofthesampleobtained.Individualinterviews:In-depthqualitativeinterviewswereconductedtoascertainproviderandconsumerimpressionsoffacilitatorsandbarrierstoservices,howpeopleinneedfindoutaboutservices,howservicesmightbebetterdelivered,gapsinservices,andsuggestionsforimprovingserviceaccessandutilization.IndividualswerecontactedbasedoninformationprovidedbytheJewishFederation.Inaddition,snow-ballsamplingwasused,withindividualsinterviewedprovidingthenamesofotherstheythoughtwouldbeparticularlyhelpfultocontacttolearnabouttheirperspectivesontheseissues.Theinterviewswereaudiotapedandtranscribedverbatim.Thetranscriptswerecodedbyaninitialcoderbasedonthegeneralquestionsaskedandreviewedbyoneormoreadditionalcoders.Theseinitialcodeswerefurthercategorizedasbelongingattheindividual,social/cultural,organizational,interorganizationalandcontextuallevels.

Page 11: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

11

SurveyResultsWepreparedtwosurveyinstruments,onefortheprovidersandonefortheconsumersofservices.ItemsweresimilartosurveyquestionsusedbyotherJewishFederationswithintheUSandwereselectedand/ormodifiedwithinputandfeedbackfromtheJewishFederationSaintLouisstafftoensuresurveyitemswereappropriatefortheSt.Louiscontext(seeappendixforquestionnaires).ServiceProvidersServiceprovidersindicatedthattheyprovidethefollowingservices:EarlyChildhoodEducation Camping(DayandResident) CulturalandEducational

ProgramsSocialServices(IndividualandGroup)

AdultDayCenter FoodServices(Pantry,Seniors,Families,MealDelivery)

FitnessandWellness YouthandFamilyPrograms Religious/SpiritualSocialJustice CommunityService Community

Building/OrganizingCounseling,Assessment,Testing

Psychiatry FinancialAssistance

ChildAbusePrevention Chaplaincy Providersindicatedthatfromtheirexperiencesthefourfactorsthatmayinfluenceconsumers’useofservicesmostarecost,stigma,familyobligationsandtransportation.Theyalsoindicatedthatthatfood,mentalhealthandchild-careserviceswerethemostutilizedservices.Servicesthatprovidersindicatedwerethemostwell-fundedwerecontinuingeducation,foodandmentalhealthservices.Housingrepair,substanceuse,andhousingaccesswereidentifiedastheleastwell-funded.Providersalsoindicatedthatwhileallservicescouldbenefitfromadditionalfundingandresourceallocation,food,eldercare,childcare,employment,andmentalhealthservicesweremostinneedofadditionalfunding.Oftheservicesweaskedprovidersabout,employment,childcare,housingrepair,mentalhealth,foodandhealthcareserviceswerementionedasbeingamongthegreatestneeds.Someprovidersalsoindicatedthatyouthhadadditionalneedssuchasorthodontics,music,art,dance,andsports.ConsumersTheaverageageofconsumerswhocompletedthequestionnairewas53,witharangeofagesbetween42and73.Fiftypercentofparticipantsdescribedthemselvesas“unabletomakeendsmeet,”andtheremaininghalfofparticipantsdescribedtheirhouseholdfinancialsituationas“justmanagingtomakeendsmeet.”Theparticipantswereprimarilyfemale(87.5%).Intermsofeducation,themajorityofparticipantshadanAssociatedegreeorsomecollegeexperience(66.67%).Themajorityofparticipants

Page 12: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

12

werereform(62.5%)withother“denominations”beingrepresentedat12.5%ofrespondentseach(orthodox,conservative,non-denominationaland“JustJewish”).Themajority(75%)ofparticipantsindicatedthatbeingJewishwasveryorsomewhatimportanttothem.WhilethissampledoesnotrepresentthecompletediversityoftheJewishpopulationexperiencingpovertyintheSt.Louisarea,thequalitativeandquantitativedataprovideddoessuggestsomeconsistentconcernsandpresentsomecompellingopportunitiesforimprovingservicestoenhanceaccessandutilization.Fiftypercentormorerespondentsindicatedthatthefollowingwerealways,often,orsometimesafactorinfluencingutilizationofservices:cost,stigma,agencyisJewishaffiliated,healthstatusandtransportation(seeTable4).Table4:FactorsinfluencingutilizationofservicesCost:55.56%statedthatthiswasalwaysoroftenafactor;11.11%statedthisissometimesafactor;and33.33%statedthisisneverafactor

Stigma:11.11%statedthatthiswasalwaysoroftenafactor;66.67%statedthisissometimesafactor;and11.11%statedthisisneverafactor

Communicationdifficultieswithproviders:11.11%statedthatthiswasalwaysoroftenafactor;22.22%statedthisissometimesafactor;and11.11%statedthisisrarelyafactor;and33.33%statedthisisneverafactor

Culturalorreligioussensitivity:44.44%statedthatthiswasalwaysoroftenafactor;44.44%statedthisisneverafactor

AgencyisJewishaffiliated:11.11%statedthatthiswasalwaysoroftenafactor;55.56%statedthisissometimesafactor;and33.33%statedthisisneverafactor

Jobobligations:33.33%statedthatthiswasalwaysoroftenafactor;11.11%statedthisissometimesafactor;11.11%statedthisisrarelyafactor;and44.44%stated

thisisneverafactor

Familyobligations:22.22%statedthatthiswasalwaysoroftenafactor;11.11%statedthisissometimesafactor;and66.67%statedthisisneverafactor

Transportation:44.44%statedthisissometimesafactor;11.11%statedthisisrarelyafactor;and44.44%statedthisisneverafactor

Healthstatus:33.33%statedthatthiswasalwaysoroftenafactor;55.56%statedthisissometimesafactor;and11.11%statedthisisneverafactor

Whenaskedabouthowlikelytheyweretouseavarietyofservices,overathirdoftherespondentsindicatedthattheywereverylikelytousethefollowing:housingrepair,employment,continuingeducation,mentalhealth,foodandhealthcare(SeeTable5).Itshouldbenotedthattheneedforsomeservicesmayhavebeendifferentinoursamplethantheoverallpopulationinneedbecauseofavarietyoffactorssuchasagedistributionorchildreninthehousehold.

Page 13: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

13

Table5:ServiceutilizationChildcare:66.67%respondedthattheynotlikelytousetheseservices;22.22%respondedthattheyaresomewhatlikelytousetheseservices;and11.11%respondedthattheyareverylikelytousetheseservices.

Servicesforchildrenandadultswithspecialneeds:66.67%respondedthattheynotlikelytousetheseservices;22.22%respondedthattheyaresomewhatlikelytousetheseservices;and11.11%respondedthattheyareverylikelytousetheseservices.

Eldercare:88.89%respondedthattheynotlikelytousetheseservices;and11.11%.

Housingrepair:33.33%respondedthattheynotlikelytousetheseservices;and66.67%respondedthattheyareverylikelytousetheseservices.

Housingaccess:66.67%respondedthattheynotlikelytousetheseservices;11.11%respondedthattheyaresomewhatlikelytousetheseservices;and22.22%respondedthattheyareverylikelytousetheseservices.

Employment:22.22%respondedthattheynotlikelytousetheseservices;33.33%respondedthattheyaresomewhatlikelytousetheseservices;and44.44%respondedthattheyareverylikelytousetheseservices.

Continuingeducation:22.22%respondedthattheynotlikelytousetheseservices;44.44%respondedthattheyaresomewhatlikelytousetheseservices;and33.33%respondedthattheyareverylikelytousetheseservices.

Substanceuse:88.89%respondedthattheynotlikelytousetheseservices;and11.11%respondedthattheyareverylikelytousetheseservices.

Mentalhealth:33.33%respondedthattheynotlikelytousetheseservices;22.22%respondedthattheyaresomewhatlikelytousetheseservices;and44.44%respondedthattheyareverylikelytousetheseservices.

Food:11.11%respondedthattheynotlikelytousetheseservices;22.22%respondedthattheyaresomewhatlikelytousetheseservices;and66.67%respondedthattheyareverylikelytousetheseservices.

Healthcare:22.22%respondedthattheynotlikelytousetheseservices;22.22%respondedthattheyaresomewhatlikelytousetheseservices;and55.56%respondedthattheyareverylikelytousetheseservices.

Page 14: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

14

QualitativeInterviewResultsSummary:Theproviderandconsumerinterviewsidentifiedanumberoffactorsthatinfluenceaccesstoandutilizationofservicesattheindividual,social/cultural,organizational,interorganizationalandcontextuallevels.Thesearesummarizedhereacrossproviderandconsumerinterviews.Thenextsectionprovidesmorespecificinformationfromtheproviderandconsumerinterviewsseparately.Intermsofindividuallevelfactorsthoseinterviewedindicatedthatthereisalackofinformationaboutservicesprovidedandtheeligibilityrequirementsforusingtheservices.Theyalsoindicatedthattherewasagreatdealofbureaucracyinaccessingservices.Respondentsalsoindicatedthatconsumersoftendonotwanttosharepersonalinformationinpartduetoembarrassmentregardinguseofservicesandinpartduetofearaboutwhathappensiftheiruseofservicesisdiscoveredbyothers.Therewereconcernsraisedaboutstigmathattheyidentifiedasbeingcreatedbythestructuresofaccessingcarenotonlyafunctionofindividualbeliefs.Intermsofsocial/culturalfactors,concernswereexpressedthatsomeprovidersmaynotbesensitivetotheuniqueneedsofJewishfamiliesandsomearticulatedalackofunderstandingofthedifferentneedsamongdenominationswithintheJewishcommunity.ThoseinterviewedalsoexpressedconcernsthatparticipatinginJewishcommunallifeisexpensive,puttingfamiliesinapositionwheretheyneedtorequestassistancebutdonotmeetmostfederaleligibilityrequirementsforservices.Itwasalsonotedthattheimportanceofthereligiousaffiliationoftheserviceagencyorspecificprovidervariesconsiderablyandtoalargeextentdependsonthetypesofservicesneeded.Inotherwords,religiousaffiliationislikelytomattermoreforthingslikefoodandmentalhealth,andlessforthingslikehousingandcarrepair.Intermsoforganizationalfactors,thoseinterviewedvoicedconcernsaboutunclearcriteriaforutilizationofservices,aswellasbureaucracyandrestrictionsonhowresourcescanbeused.Thoseinterviewedalsopointedtoconcernsaboutinsufficientservices,inconvenienthoursofservice,andlimitedlocationsandservicemodels.TherewerealsoconcernsthattheservicesprovidedwithintheJewishcommunityareinferior.Inpart,thiswasattributedtostaffturnover,andasaresultstaffnotknowingaboutserviceswithintheirownagencies.Intermsofinterorganizationalfactors,thoseinterviewednotedthatJewishagenciesoftendon’treferindividualsorfamiliestoeachother.Thiswasidentifiedasbeinginpartduetothefactthattheyareunawareofwhatotherorganizationsoffer.Theyalsonotedthesignificantproblemscausedbyinteragencysilos.Thoseinterviewedvoicedtheneedforinteragencyagreementstoeasetheuseofservices,andthesharingofcaseinformationtoreducetheburdenonfamilies.TheyalsohighlightedtheneedforJewishandnon-Jewishagenciestocreatewaystoshareinformationaboutservicesandworkmorecollaboratively.Inconsideringcontextualfactors,theoneissuethatwasnotedrepeatedlywaschallengeswithtransportation.Thoseinterviewedalsonotedthatthereisageneralneedforadditionalservices,particularlymentalhealthservices,homeimprovement,andnecessitiesbeyondfood(e.g.,toiletpaper,toothpaste).

Page 15: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

15

BarrierstoaccessandutilizationofservicesProvidersIndividualbarriers

Theprovidersinterviewedidentifiedanumberofindividuallevelfactorsthatinfluenceaccesstoandutilizationofservices.Oneofthemostimportantfactorsidentifiedisthatpeopleinthecommunitydon’tknowabouttheservicesavailable.Evenwhenpeopledoknowaboutservices,providersindicatedthattheindividualsandfamiliesmaynotknowiftheyareeligible.

Anotherbarrieridentifiedbyserviceprovidersisthattoaccessservicesoftenrequireson-lineorautomatedphoneservicesthatmanyinthecommunity,particularlytheelderly,arenotcomfortableusing.Providersalsofeltthatconsumersofservicesmaynotwanttodiscloseinformationthatisrequiredtoaccessservices.

Providersindicatedthatsomeindividualsandfamiliesdonotaccessorutilizeservicesbecausetheydonotself-identifyasbeinginneedofservices,aren’tmotivatedtouseservices,orareanxiousaboutgoingtounknownplaces.Providersalsohadexperienceswithindividualsandfamilieswhohavehadconcernsthatacknowledgingtheirproblemsandusingserviceslessenstheirdignity.Theyfeltthatsomeconsumersmayfeelembarrassedaboutthestigmaassignedtothemifothersfindoutabouttheirneeds.Theyalsohadexperiencesthatsuggestedthatconsumershaveconcernsabouttheimpactontheirbusinessesifpeopleinthecommunityweretodiscovertheyhavefallenondifficulttimes.Social/Culturalbarriers

Providersidentifiedsomeimportant,potentiallyunique,socialandculturalbarrierstoJewishfamiliesandindividualsaccessingandutilizingservices.AsstatedbyoneproviderthereisaquestionastowhetherornotthedifferentmanifestationofissueswithintheJewishcommunitywarrantsauniquesetofreflectivetoolsorevencriteriaforservices.Forexample,doesayoungpersonexperiencingmentalhealthchallengesneedaJewishcounselorsothattheresponsetotheissuescanbeconsistentwiththeteachingwithintheJewishtraditions?Similarly,whatiffamilieshavesufficientresourcestomeetwhatmightsecularlybedefinedasbasicneeds,buttheydonothavesufficientresourcestoallowtheirparticipationinJewishcommunallife,shouldtheybeeligibleforservices?

Whenaskedaboutreferrals,providersindicatedthattheymakereferralstoeitherJewishorsecularagenciesbasedonwhattheythinktheindividualconsumerisgoingtobecomfortablewithusing,andinSt.Louis“comfort”mayberelatedtogeographiclocationasmuchasreligiousaffiliation.Providersnotedthattheirdecisiononwheretoreferindividualsalsohastodowiththeindividualand/orfamilypreferenceregardingseekingcarewithintheJewishcommunity.SomeindividualsandfamiliesclearlyprefertostaywithintheJewishcommunity,otherspriceshop,andstillothersprefernottobeservedwithintheJewishcommunity.

OtherprovidersnotedthatsomepartsoftheOrthodoxcommunitydonotseeitasaquestionofthedifferencebetweentheJewishFederationrelatedservicesandsecularorotherreligiousdenominationservices.TheyseethattheOrthodoxcommunityhasauniquewaythattheyneedtobeservedandthateventheFederationoftendoesnotserveorrepresentthem.

Organizationalbarriers

Providersidentifiedanumberofbarrierswithintheirownorganizationsthatimpactaccesstoandutilizationofservicesincludinguncleareligibilitycriteria,toomuchbureaucracytoaccessservices,andrestrictionsandrulesthatlimitaccess.Anotherconcernvoicedbyprovidersisthatstaffturnoverisveryhighatsomeoftheorganizationswithinthecommunity.Peoplevoicedfrustrationoverlosingqualitystafftoservethecommunity.Thoseinterviewedalsonotedthatthishasledtosomenegativeexperiencesusingservicesandaperceptionthatthestaffwhostayworkingattheseagenciesareofinferiorquality.

Page 16: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

16

Providersalsovoicedaconcernthattheagenciesinthecommunityhaveinsufficientresourcestomeettheneedsinthecommunity.Thiswasinpartarticulatedasinsufficientfundingforexistingresourcesandinpartaconcernthattheservicesneededarenotavailable.Serviceprovidersacknowledgedthattherearemanymorepeoplewhocouldusetheservicesthanarecurrentlyusingthem.Thiswasinpartattributedtothingslikeservicehoursbeinginconvenientandinparttopeoplenotknowingthatservicesareavailableorpeoplewhodonothavethecapacitytoaskforhelp.

Providersalsonotedthatthereareanumberofdifferentvulnerablepopulationsinthearea–thosewhoarethemostvulnerableandunabletoseekhelp,thosevulnerableandabletorequestassistance,andthosewhoseekassistancebutmaynotreallyhavethesamekindsofneeds.Itmaywellbethateachisbestservedthroughdifferentagenciesorapproaches.Interorganizationalbarriers

Providersnotedthatthereareseveralchallengestoworkingacrossorganizationsthattakeawayfromservingthecommunityinthebestwaypossible.Forexample,agenciesoftendon’trefertoorreceivereferralsfromotherJewishagencies.Thiswasattributedatleastinparttonotknowingwhatserviceseachotheroffer.Providersalsoindicatedthatwhenreferralsareprovidedthereisofteninsufficientinformationsharedbetweenagencies,placinganadditionalburdenonindividualsandfamilies.Providersreportedthatthereareinteragencysilosandbarrierstoworkingtogether,andthatthereshouldbewaystostreamlineinteragencyservicestobetterservethecommunity.ContextualBarriers

Providersnotedsomecontextualfactorsthatserveasbarrierstoindividualsandfamiliesseekingservices.Mostnotably,providersmentionedthatthereare“terrible”publictransportationoptions.

ConsumersIndividualbarriers

Serviceconsumersidentifiedanumberofsimilarbarriersasthoseidentifiedbyserviceproviders.Forinstance,theynotedthatforsomeitisnoteasytoaskforhelp.Consumersalsovoicedatensionbetweenexperiencingexternalstigmaandinternalembarrassmentassociatedwithaskingforhelp,yetmostindicatedthatfromtheirexperienceitisacceptableinthecommunitytoaskforhelp.Infact,somestatedthatintheirmindstherealityisthateveryoneneedssomesortofhelpatsomepointintheirlives.

Anotherbarrierconsumersidentifiedwasthatmanyindividualsdonotknowwhatservicesareavailable.SomestatedthatthislackofawarenessisbecauseofthewaytheFederationandassociatedagenciesshareinformationaboutservices.Social/culturalbarriers

WhenaskedifaccessingandutilizingservicesmightbeinfluencedbywhetherornottheagencyisJewish,secularorhostedbyadifferentreligiousgrouptheoveralltakehomemessagewas”itdepends.”Forsomethereisageneralsenseof“yesitisimportant”or“noitisnotimportant”thattheindividualbeJewishortheagencybepartoftheJewishcommunity.Forothers,therearesomeserviceswherereligiousandcultural“fit”makeadifference(e.g.,food)butotherserviceswhere“fit”isnotanissue(e.g.,housing,clothing,carrepair).Forstillothers,particularlysomeelementsoftheOrthodoxcommunity,evenservicesprovidedwithinJewishagenciesareoftennotseenasfittingcommunityneeds.SomearticulatedthattheOrthodoxcommunitydoesnotalwaysexpect,ornecessarilywant,theseservicestobeprovidedbytheFederation.Rathertheyseetheseneedsasbeingmore

Page 17: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

17

appropriatelyaddressedbythesynagogueandcongregantsofthatsynagogue.SomeconsumershadsomeconcernswiththenotionthatJewishindividualsandfamiliesshouldbetakencareofbytheirownandshouldtakecareoftheirown,asforthemitreflectedconcernsaboutinsularity.Organizationalbarriers

Serviceconsumersidentifiedanumberoforganizationalbarrierstoaccessingandutilizingservicesincludinginconvenientservicehours,eligibilityrequirements,applicationprocesses,andthelackofflexibleservicemodels.Theyalsonotedthatthereseemtobemorepeopleinneedthanresourcesavailabletoservethem.

Consumersalsonotedthatpeopledon’tknowaboutservicessotheydon’tevencalltoobtainthem.Othersnotedthatwhentheyhavecalledlearnaboutservicesthestaffattheagenciesdidn’tknowaboutservicesofferedintheirownagency.Consumersemphasizedthattheservicesneededgoesbeyondfoodtohealthcare,mentalhealthcare/counseling,homerepair,utilities,furniture,clothes,domesticviolence,seniorservices,tutoringforschool,consolidatingdebt,jobs,loans,casemanagement,etc.

Page 18: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

18

FacilitatorstoaccessandutilizationofservicesProvidersIndividuallevelfacilitators

Whenproviderswereaskedaboutthekindsofthingthatfacilitateindividualsandfamiliesaccessingservices,firstandforemosttheyindicatedthatitisimportanttoensurethattheyknowthattheyarenottheonlyoneswhohavetheirneeds.Consumersneedtobeinteractedwithinwaysthathelptopreservedignityandensurethattheyunderstandthattheyarenotbeingjudged.Severalprovidersstatedthatthesemessagesshouldbehighlightednotonlyforthoseusingservicesbutalsowhenmarketingservices.Social/Culturalfacilitators

Providersnotedthatitisimportanttobuildrelationshipswithindividualsandfamiliessothattheyknowthatitisacceptabletocometothemwhenhelpisneeded.Organizationalfacilitators

Providersofferedsomesuggestionsthatwouldhelpindividualsandfamiliestoaccessservices.Inparticular,theyemphasizedincreasingreferralsbyinformingadvocatesandenhancingadvertising.Theyalsonoted,however,thatalreadytherequestsforservicesexceedwhattheycanprovide,soadditionalfundingandfundraisingareimportant.

Providersalsohighlightedthattherearethingsthatcanbedonetoreducetheburdenofthebureaucracyassociatedwithtryingtoaccesscare,suchasassistingwithcompletingandsubmittingformsandenhancinginteragencysharingofinformation.

Providersencouragedmoreflexibilitywithhowandwhereservicesareprovided,inotherwordsthecreationofalternativeservicemodels.Forsomethismeantgoingtoindividualshomestoprovideservices.Otherssuggestedprovidingfoodorclothingatsynagoguesorschools.ConsumersFacilitatorstoaccessandutilizationofservices

Whenserviceconsumerswereaskedaboutthatfacilitatesindividualsandfamiliesaccessingandutilizingservicesthey,liketheproviders,highlightedtheimportanceofemphasizingthatthateveryoneneedshelp.SomealsonotedthattheygototheirRabbitogetassistance.

Page 19: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

19

Opportunitiesforactionandreflection

OpportunitiesforactionBasedonourfindings,thereisnotonesinglebestapproachforimprovingservicestoJewish

individualsandfamilieslivinginpovertyintheSt.Louisarea.Ratherthemostimportantchangesmaybedifferentdependingonthecircumstance,theindividual,andtheirdenomination.However,bothprovidersandconsumershadsomekey,andconsistent,recommendations.Someoftheserecommendationsarethedirectextensionofchallengesthatwerehighlighted(e.g.,peopledon’tknowaboutservices),whileothersarestrategiesidentifiedbythoseinterviewed(e.g.,tellpeopleinthecommunityaboutservicesthroughprintmedia,socialmedia,orinperson).Morespecifically,thedatasuggestthatinordertoimproveaccesstoandutilizationofservicestheFederationneedsto1)improvemarketing/communicationtoincreaseawarenessofandinformationaboutservices,2)establishformalnetworksandcollaborationamongserviceproviders,3)createopportunitiesforprovidingon-going,confidentialfeedbackonhowtoimproveservices,and4)createalternativeserviceprovisionmodels.Marketing/communicationtoincreaseawarenessofandinformationaboutservices

Providersandconsumersemphasizedtheneedforincreasingtheamountandvarietyofinformationaboutservices.SpecificsuggestionsincludedwrittenorprintinformationthroughtheJewishLightorbulletinboardpostings,socialmedia/Facebook,andemailsthroughvariouslistserves.Itwassuggestedthatthesebedistributedinwaysthatdirectlyreachserviceprovidersandpotentialconsumers,aswellastothosewhointeractwithpotentialconsumerseitherbecauseoftheirformalrolesinthecommunity(e.g.,RabbisandCantors)ormoreinformallythroughelectronicmedia(Facebook,blogsorothersocialmedia)orinpersonsocialgroups.Creationofnetworksandcollaborationamongserviceproviders

Bothprovidersandconsumersechoedwhattheysawasthepotentialbenefitsofenhancingcollaborationandnetworkingamongserviceproviders.Therecommendationsincludeddevelopingbetterwaystoshareinformationbothaboutconsumersandservicesprovidedbytheagencies;enhancingcasemanagementand/orreferrals;andco-locatingservices(foodpantrytosynagogue,socialservicesatfoodpantry).ThesesuggestionscallupontheagenciesfundedbytheFederationandthosethatoperateoutsideofthisfundingtoworktogethertomovealongwhatsomehavecalledacontinuumofcollaboration:

• unlinked–donotworktogetheratall,• networking–shareinformationonly,• coordinating–mutualreferralandcomplimentaryorganizationalactionplanning,• cooperating–shareresourcesandhaveawrittenagreementtoformalizecollectiveaction,or• collaborating–jointactionthatmutuallybenefitseachorganizationandofteninvolvessharing

risks,responsibility,andrewards.7ThisisconsistentwithwhatotherJewishFederationshavefoundintheirworktobetterunderstandhowtoaddresspovertyintheircommunities.Forexample,inCleveland,OHtheJewishFederationconductedasimilarstudytothisoneandasaresultinitiatedaroundtableofallagenciesthatworkwith7Himmelman,A.T.Definitions,decision-makingmodels,roles,andcollaborationprocessGuide.

Minneapolis.HimmelmanConsulting;2002

Page 20: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

20

individualsandfamiliesindistress.Thegroupmeetsonaregularbasistolearnaboutwhateachisdoingandhowtheycanbesthelpeachothertoaccomplishtheirobjectives.Opportunitiesforon-going,confidentialopportunitiesforprovidingfeedbackonhowtoimproveservices

Basedontheresponsesfromprovidersandconsumersitappearsthatthereisminimalopportunityforconsumersandstaffofagenciestoidentifywhattheythinkisgoingwellandwhatcouldbeimprovedinserviceprovision.Buildingthisinonaregularbasiswill“normalize”theprocessofrequestingfeedbackandprovidevaluableinformationonwhatchangescanandneedtobemadetobetterservethecommunity.Alternativeserviceprovisionmodels

ThoseinterviewedalsoencouragedtheFederationtoconsiderthecreationofalternativeserviceprovisionmodels.SomeofthiswasseenasenhancingcasemanagementservicesprovidedwithintheJewishcommunitywhileothersencouragedtheuseofmoresecularservicessuchastheUnitedWay211line.Thoseinterviewedalsoenvisionedbroadertypesofchangessuchasagenciesgoingtoindividual’shomes,orprovidingmultipleservicesatsingleagencies.Stillothersarticulatedtheimportanceofworkingwithintheformalandinformalstructuresoftemplesandsynagoguestoeitherprovideprofessionalservicesatthetemple/synagogueitselfortotraincongregationmembersaboutservices,orwhatothershavecalledlaynavigatororadvocateprograms.

OpportunitiesforreflectionWearethey:Ourfindingsindicatethatconsumersandproviderspointedtosimilarfactorsfacilitatingandgettinginthewayofaccessingandutilizingservices.ThismaybeinpartbecausesomeoftheproviderswespokewithhadneededtouseFederationservicesatsomepointintheirlives,andsomeoftheconsumersactuallyworkedwiththeFederationorother/affiliatedsocialservicesatsomepointintheirlives.Whilesomeconsumersmentionedthatthereisastigmaassociatedwithusingservicesamongthosewespoketo(obviouslyalimitedsample)theysawmuchofthestigmaandshamebeingexacerbatedbyexternalperspectivesoftheagenciesservingthem.Theconsumerperspectivewasthateveryoneneedshelpnowandthen.Someconsumersindicatedthattheyexperienceserviceprovidersandstructuresas“labeling”themaspeoplewholiveinpovertyratherthanpeoplecurrentlyinneedofservices.Weobtainedabiasedperspective:Itisinevitablethatwewillmisssomeperspectives,particularlytheperspectivesofthoseinmostdirestraits.Themostvulnerableareunlikelytobeinaplaceorcomfortabletospeakwithusandreflectontheirexperiencesbecausetheyareinthemidstoftheirmostdifficulttimes.Itwasevident,however,thatthebiasedperspectiveweobtainedwasnotjustduetothis.Thebiasoftheinformationweobtainedwasexacerbatedbyagencyprovidershavingconcernsaboutconnectinguswiththeirconsumers.Forthemostpartagencyprovidersexpressedthisasafunctionoftheirconcernaboutconfidentiality.However,italsohighlightsthatmostagenciesdonothaveanon-going,confidentialmeansofenablingconsumerstoprovidefeedbackandsuggestionsonhowtoimproveservices.Itisimportanttohelpagenciesidentifystrategiesthatcanbeemployedtoensureconfidentiality.Definitionsof“basicneeds”differ:Itisimportanttotakeintoaccountthatsomefamilieshavethemoneyforwhatthesecularcommunitymightcallthebasics,butwhatisconsideredthebasicsfor

Page 21: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

21

participatinginJewishlife(specificsummercamps,visitstoIsrael)ismoreexpensive.Whatthismeansinpracticeisthatwhilefamiliesmayself-identifyasneedingassistanceandmayaskforhelptheymaybeturnedawaybecausetheydonotmeetfederalcriteriaforobtainingservices.Itisalsoworthnotingthatseveralhavequestionedifthefederalpovertyisthebestmetricforunderstandingneed.Somehavesuggestedthatabasiclivingmeasure(theamountthathouseholdswouldhavetoearntocovertheirbasicexpenses)isabettermetric.8Whataretheimplicationsof“wetakecareofourown?”:Weheardthisphraseseveraltimesoverthecourseofourinterviewswithbothprovidersandconsumers.Inpart,thiswasdescribedasafunctionofhistory;thatthebroadersecularcommunityhasnothistoricallyprovidedtheJewishcommunitywithservices.Ontheotherhand,somemembersoftheJewishcommunitynotedtheimportanceof“takingcareofourown”becausesecularservicesmightbeofferedinwaysthatarenotculturallysensitive.Thismightbeanythingfromhavingaproviderwhowearsaminiskirt,tosomeonehandlingfoodimproperly,tonotunderstandingculturalnorms.OneofthechallengesvoicedbyconsumersandprovidersasfacingtheJewishcommunityinSaintLouisistowhatextentshouldtheJewishcommunitybeprovidinguniqueservicesversusutilizingbroadercommunityservices?GiventheJewishcommunityisaheterogeneous,nothomogenous,community,ifthereareseparateservicestowhomshouldtheybegeared?ToaddevenmorecomplexityotheraskedabouttheextenttowhichtheJewishcommunityshouldprovideforotherswhodonotsharetheJewishfaithandculture?8https://www.stl.unitedway.org/2017/04/united-way-releases-new-basic-living-measure-region/

Page 22: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

22

Appendix:SurveyInstruments

Page 23: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

23

JewishFederationServiceProviderSurvey

StartofBlock:DefaultQuestionBlock

Q1Whatisthenameofyouragency?

________________________________________________________________

Q2Whatisyourroleintheagency?

________________________________________________________________

Q3Whatisthemission/goalofyouragency?

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

Q4Whatservicesdoesyouragencyprovide?

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

Page 24: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

24

________________________________________________________________

Q5HowoftendothefollowinginfluenceutilizationofservicesbyJewishindividualsandfamilieslivinginpoverty?

Always/Often(1)

Sometimes(2) Rarely(3) Never(4) Don'tKnow

(5)

Cost(1) ▢ ▢ ▢ ▢ ▢

Stigma(2) ▢ ▢ ▢ ▢ ▢

Communicationdifficultywithprovider(3) ▢ ▢ ▢ ▢ ▢

Culturalorreligious

sensitivity(4) ▢ ▢ ▢ ▢ ▢

AgencyisJewish

affiliated(5) ▢ ▢ ▢ ▢ ▢

JobObligations(6) ▢ ▢ ▢ ▢ ▢

Familyobligations(7) ▢ ▢ ▢ ▢ ▢

Transportation(8) ▢ ▢ ▢ ▢ ▢

HealthStatus(9) ▢ ▢ ▢ ▢ ▢

Other(Pleasespecifyand

indicatelevelofinfluence)(10) ▢ ▢ ▢ ▢ ▢

Page 25: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

25

Q6Belowpleaseindicatewhichservicesyourorganization/agencyprovides.Whichwouldyousayiswell-utilizedversusunderutilizedbyJewishindividualsandfamilieslivinginpoverty?

Don'tProvide(1) YesProvide(2) WellUtilized(3) UnderUtilized(4)

ChildCare(1) ▢ ▢ ▢ ▢

ElderCare(2) ▢ ▢ ▢ ▢

HousingRepair(3) ▢ ▢ ▢ ▢

HousingAccess(4) ▢ ▢ ▢ ▢

Employment(5) ▢ ▢ ▢ ▢

ContinuingEducation(6) ▢ ▢ ▢ ▢

SubstanceUse(7) ▢ ▢ ▢ ▢

MentalHealth(8) ▢ ▢ ▢ ▢

Food(9) ▢ ▢ ▢ ▢

HealthCare(10) ▢ ▢ ▢ ▢

Other:PleaseSpecify(11) ▢ ▢ ▢ ▢

Other:PleaseSpecify(12) ▢ ▢ ▢ ▢

Page 26: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

26

Page 27: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

27

Q7Intermsoffunding,howwellfundedareeachoftheservicesyouprovide?

Don'tProvide(1) WellFunded(2) InsufficientlyFunded(3) NotFunded(4)

ChildCare(1) ▢ ▢ ▢ ▢

ElderCare(2) ▢ ▢ ▢ ▢

HousingRepair(3) ▢ ▢ ▢ ▢

HousingAccess(4) ▢ ▢ ▢ ▢

Employment(5) ▢ ▢ ▢ ▢

ContinuingEducation(6) ▢ ▢ ▢ ▢

SubstanceUse(7) ▢ ▢ ▢ ▢

MentalHealth(8) ▢ ▢ ▢ ▢

Food(9) ▢ ▢ ▢ ▢

HealthCare(10) ▢ ▢ ▢ ▢

Other:PleaseSpecifyand

indicateleveloffunding.(11) ▢ ▢ ▢ ▢

Other:PleaseSpecifyandindicateleveloffunding.(12) ▢ ▢ ▢ ▢

Page 28: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

28

Q8TowhatextentdoJewishindividualsandfamilieslivinginpovertyhaveanunmetneedforthefollowingservices?

Agreatneed(1) ModerateNeed(2) NoNeed(3)

ChildCare(1) ▢ ▢ ▢

ElderCare(2) ▢ ▢ ▢

HousingRepair(3) ▢ ▢ ▢

HousingAccess(4) ▢ ▢ ▢

Employment(5) ▢ ▢ ▢

ContinuingEducation(6) ▢ ▢ ▢

SubstanceUse(7) ▢ ▢ ▢

MentalHealth(8) ▢ ▢ ▢

Food(9) ▢ ▢ ▢

HealthCare(10) ▢ ▢ ▢

Schoolsupplies(13) ▢ ▢ ▢

Other:PleaseSpecifyandindicatelevelof

need.(11) ▢ ▢ ▢

Page 29: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

29

Q9Intermsoffunding,howwellfundedareeachoftheservicesinthecommunity,regardlessofwhetheryouprovidetheseservices?

WellFunded(1) InsufficientlyFunded(2) NotFunded(3)

ChildCare(1) ▢ ▢ ▢

ElderCare(2) ▢ ▢ ▢

HousingRepair(3) ▢ ▢ ▢

HousingAccess(4) ▢ ▢ ▢

Employment(5) ▢ ▢ ▢

ContinuingEducation(6) ▢ ▢ ▢

SubstanceUse(7) ▢ ▢ ▢

MentalHealth(8) ▢ ▢ ▢

Food(9) ▢ ▢ ▢

HealthCare(10) ▢ ▢ ▢

Other:PleaseSpecifyandindicatehowwell

funded.(11) ▢ ▢ ▢

Other:PleaseSpecifyandindicatehowwell

funded.(12) ▢ ▢ ▢

Page 30: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

30

Q10Whichofthefollowinggroupsareservedbyyouragency?PleaseCheckallthatapply.

▢ Children(Ages0-18)(1)

▢ Adults(Ages19-64)(2)

▢ Elderly(Ages64andup)(3)

▢ Families(4)

▢ IndividualFamiliesLivinginPoverty(5)

▢ Unemployed(6)

▢ IndividualswithIllnessorDisabilities(7)

▢ Caregivers(8)

▢ Males(9)

▢ Females(10)

Q11IsthereanythingelsethatyouthinkwouldbehelpfulforustoknowinordertobetteraddresstheneedsofJewishindividualsandfamilieslivinginpoverty?

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

Page 31: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

31

JewishFederationStudywithJewishCommunityMembers/Consumers

StartofBlock:DefaultQuestionBlock

StartofBlock:DefaultQuestionBlock

Q1Howoftendothefollowinginfluenceutilizationofservicesbyyouand/orothermembersoftheJewishCommunity?

Always/Often(1)

Sometimes(2) Rarely(3) Never(4) Don'tKnow

(5)

Cost(1) o o o o o Stigma(2) o o o o o

Communicationdifficultywithprovider(3) o o o o o Culturalorreligious

sensitivity(4) o o o o o AgencyisJewish

affiliated(5) o o o o o JobObligations

(6) o o o o o Family

obligations(7) o o o o o Transportation

(8) o o o o o HealthStatus

(9) o o o o o

Page 32: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

32

Q2Howlikelyareyouoryourfamilytousetheservicesbelowiftheywereavailable?

Notatalllikely(1)

Somewhatlikely(2) Verylikely(3) Don'tKnow(4)

ChildCare(1) o o o o Servicesfor

children/adultswithspecialneeds(2)

o o o o ElderCare(3) o o o o HousingRepair

(4) o o o o HousingAccess

(5) o o o o Employment(6) o o o o ContinuingEducation(7) o o o o SubstanceUse

(8) o o o o MentalHealth(9) o o o o

Food(10) o o o o HealthCare(11) o o o o Other:PleaseSpecify(12) o o o o Other:PleaseSpecify(13) o o o o

Page 33: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

33

Q3Whatisyourage?

________________________________________________________________

Q7Whichofthestatementsbestdescribesyourhousehold'sfinancialsituation?

o Cannotmakeendsmeet(1)o Justmanagingtomakeendsmeet(2)o Haveenoughmoney(3)o Havesomeextramoney(4)o Well-off(5)

Q9Pleaseindicateyourmaritalstatus.

o Married(1)o Livingwithapartner(2)o Singlenevermarried(3)o Divorced(4)o Separated(5)o Widowed(6)

Page 34: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

34

Q10Whatisyourgender?

o Male(1)o Female(2)o Transgender/Transsexual(3)

Q11Whatisthehighestlevelofeducationyouhaveattained?

o Highschooldiplomaorless(1)o GED(2)o AssociatesDegree(somecollege,non-B.S.N.nursingdegrees)(3)o Bachelors(includesNursingB.S.N.)(4)o Bachelorsplussomegraduatework(5)o MastersDegree,MastersLevel(6)o Ph.D.,Ed.D.,otherDoctorate(7)o J.D.,L.L.M.,J.S.D.(Lawyer)(8)o M.D.,O.D.,D.D.S.(Physician,Osteopath,Dentist)(9)

Q14Whatisthezipcodeofyourpermanentresidence?

________________________________________________________________

Page 35: Increasing understanding of the factors influencing access ... · Increasing understanding of the factors influencing access to and utilization of services among Jewish individuals

35

Q12Whatisyourdenomination,ifany?

o Orthodox(1)o Conservative(2)o Reform(3)o Reconstructionist(4)o Nodenomination--JustJewish(5)o Other,PleaseSpecify(6)________________________________________________

Q13Atthistime,howimportantisbeingJewishinyourlife?Isit...

o Veryimportant(1)o Somewhatimportant(2)o Notveryimportant(3)o Notatallimportant(4)

EndofBlock:DefaultQuestionBlock