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Field
Abstract
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Before
Background and target population
As part of the fiscal year 2021-22 budget agreed to by California’s Governor and the Legislature, the California Department of Social Services (CDSS) is providing support and oversight for five pilot programs conducting a randomized controlled trial of guaranteed income (GI). The intervention targets two unique low-income populations facing a key life transition that puts them at higher risk for adverse outcomes: youth aging out of extended foster care and pregnant people.
Eligibility criteria
The eligibility criteria for each target population is as follows:
Former foster youth (FFY)
- Low-income according to Insight Center’s Family Needs Calculator based on county of residence and household composition at time of application
- Exiting/exited foster care on their 21st birthday during the site’s enrollment period
- Can apply up to 90 days before and up to 30 days after their 21st birthday
- California resident at time of application
- Can be temporarily living out of state if attending post-secondary institution
- Foster care case is/was under the jurisdiction of a county in the site’s catchment area
Pregnant population
- Low-income (definition varied by site, with some sites using the Insight Center’s Family Needs Calculator, some using Medicaid enrollment, and some using 80% of AMI)
- Within the first 27 weeks of pregnancy at the time of application
- Resides in the site’s catchment area
- Some sites have additional criteria based on risk factors for perinatal complications (e.g., be at increased risk of developing gestational diabetes, have one or more risk factors for pre-term birth)
Application and enrollment
Each of the pilot sites follows their own specific outreach and referral process for potential program participants. People who wish to participate in the GI pilot program must complete an application online determine if they meet the pilot site’s eligibility criteria. Those who are eligible and interested then enroll in the study.
Intervention groups and randomization procedures
Enrolled participants are randomized to either receive GI or be part of a control group that receives $20 per month. For FFY, GI consists of unconditional cash payments of $750 per month for 18 months. For pregnant people, GI consists of unconditional cash payments of $600-$1,200 per month for 12-18 months (duration and amount of payment vary by site). GI recipients also receive benefits waivers for some benefits, ensuring that the income they receive from GI does not impact their current benefits. CDSS secured benefits waivers for CalWORKs and CalFresh for all GI participants, and some pilot sites secured additional waivers from county agencies. Voluntary benefits counseling and other support services are offered to enrolled participants.
For all but one site (see more detailed explanation below in the Randomization Method section), the study team at Urban Institute conducts the random assignment using applicants’ data collected in the online platform. Randomization is conducted separately by pilot site.
Sample size
We anticipate enrolling a total of 3,021 participants in the study. This includes 774 FFY (395 treatment, 379 control) and 2,247 pregnant people (1,156 treatment and 1,091 control).
Data collection
Enrolled participants are offered the opportunity to participate in surveys to study the impact of GI. Surveys will be conducted at baseline, 3 and 9 months after enrollment, upon program exit (either 12 months or 18 months post-baseline, depending on the pilot site), and 6 months after program exit. We are also obtaining administrative data from several sources to examine outcomes related to GI. These data include records such as benefits records, Medicaid records, employment and wage data, and child welfare data.
Outcomes
The outcomes of interest for both populations include physical health, mental health, financial strain and well-being, housing security, food security, transportation security, employment, education, child welfare involvement for participants with children, and participation in other benefits. For the FFY population only, we will examine criminal justice involvement. For the pregnant population only, we will examine perinatal mental health, perinatal health conditions, and birth outcomes.
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After
Background and target population
As part of the fiscal year 2021-22 budget agreed to by California’s Governor and the Legislature, the California Department of Social Services (CDSS) is providing support and oversight for five pilot programs conducting a randomized controlled trial of guaranteed income (GI). The intervention targets two unique low-income populations facing a key life transition that puts them at higher risk for adverse outcomes: youth aging out of extended foster care and pregnant people.
Eligibility criteria
The eligibility criteria for each target population is as follows:
Former foster youth (FFY)
- Low-income according to Insight Center’s Family Needs Calculator based on county of residence and household composition at time of application
- Exiting/exited foster care on their 21st birthday during the site’s enrollment period
- Can apply up to 90 days before and up to 30 days after their 21st birthday
- California resident at time of application
- Can be temporarily living out of state if attending post-secondary institution
- Foster care case is/was under the jurisdiction of a county in the site’s catchment area
Pregnant population
- Low-income (definition varied by site, with some sites using the Insight Center’s Family Needs Calculator, some using Medicaid enrollment, and some using 80% of AMI)
- Within the first 27 weeks of pregnancy at the time of application
- Resides in the site’s catchment area
- Some sites have additional criteria based on risk factors for perinatal complications (e.g., be at increased risk of developing gestational diabetes, have one or more risk factors for pre-term birth)
Application and enrollment
Each of the pilot sites follows their own specific outreach and referral process for potential program participants. People who wish to participate in the GI pilot program must complete an application online determine if they meet the pilot site’s eligibility criteria. Those who are eligible and interested then enroll in the study.
Intervention groups and randomization procedures
Enrolled participants are randomized to either receive GI or be part of a control group that receives $20 per month. For FFY, GI consists of unconditional cash payments of $750 per month for 18 months. For pregnant people, GI consists of unconditional cash payments of $600-$1,200 per month for 12-18 months (duration and amount of payment vary by site). GI recipients also receive benefits waivers for some benefits, ensuring that the income they receive from GI does not impact their current benefits. CDSS secured benefits waivers for CalWORKs and CalFresh for all GI participants, and some pilot sites secured additional waivers from county agencies. Voluntary benefits counseling and other support services are offered to enrolled participants.
For all but one site (see more detailed explanation below in the Randomization Method section), the study team at Urban Institute conducts the random assignment using applicants’ data collected in the online platform. Randomization is conducted separately by pilot site.
Sample size
We anticipate enrolling a total of 3,021 participants in the study. This includes 774 FFY (395 treatment, 379 control) and 2,247 pregnant people (1,156 treatment and 1,091 control).
Data collection
Enrolled participants are offered the opportunity to participate in surveys to study the impact of GI. Surveys will be conducted at baseline, 3 and 9 months after enrollment, upon program exit (either 12 months or 18 months post-baseline, depending on the pilot site), and 6 and 12 months after program exit. We are also obtaining administrative data from several sources to examine outcomes related to GI. These data include records such as Homeless Data Integration System (HDIS) data, CWS/CMS (California child welfare), National Student Clearinghouse and California Community College Chancellor’s Office (higher education outcomes), California Employment Development Department (employment outcomes), CalWORKs (TANF) and CalFresh (SNAP) (public assistance utilization), Medi-Cal (Medicaid) enrollment and claims (healthcare utilization and outcomes), and California Department of Justice (justice system outcomes). We will follow participants for 24 months after GI ends (or 3.5 years post-randomization) using administrative data.
Outcomes
The outcomes of interest for both populations include physical health, mental health, financial strain and well-being, housing security, food security, transportation security, employment, education, child welfare involvement for participants with children, and participation in other benefits. For the FFY population only, we will examine criminal justice involvement. For the pregnant population only, we will examine perinatal mental health, perinatal health conditions, and birth outcomes.
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Field
Primary Outcomes (Explanation)
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Before
The primary outcomes for FFY will be measured as follows:
• Healthcare utilization and access
o Delay or avoid healthcare – This outcome will examine whether participants in the treatment group were less likely to delay or avoid healthcare due to cost or other barriers compared to participants in the control group. This outcome will be measured through participants’ responses to survey items drawn from the BRFSS (Pierannunzi, Hu, & Balluz, 2013). We will also measure change over time within individuals.
o Obtain routine healthcare – This outcome will examine whether participants in the treatment group were more likely to obtain routine healthcare compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about obtaining healthcare and also through MediCal claims data. We will also measure change over time within individuals.
• Mental health
o Depression – This outcome will examine whether participants in the treatment group were less likely to experience depression compared to participants in the control group. This outcome will be measured through participants’ responses to the PHQ-8 (Kroenke et al., 2009) on the survey. We will also measure change over time within individuals.
o Anxiety – This outcome will examine whether participants in the treatment group were less likely to experience anxiety compared to participants in the control group. This outcome will be measured through participants’ responses to the GAD-7 (Spitzer et al., 2006) on the survey. We will also measure change over time within individuals.
o Perceived stress – This outcome will examine whether participants in the treatment group were less likely to experience stress compared to participants in the control group. This outcome will be measured through participants’ responses to the PSS-4 (Karam et al., 2012) on the survey. We will also measure change over time within individuals.
• Financial strain and well-being
o Financial stress – This outcome will examine whether participants in the treatment group were less likely to experience financial stress compared to participants in the control group. This outcome will be measured through participants’ responses to the PRAMS Financial Stress instrument (https://www.cdc.gov/prams/index.htm) on the survey, specifically the question about how often they were stressed about having enough money to pay their bills. We will also measure change over time within individuals.
o Financial well-being – This outcome will examine whether participants in the treatment group were more likely to experience financial well-being compared to participants in the control group. This outcome will be measured through participants’ responses to the CFPB Financial Wellbeing instrument (https://files.consumerfinance.gov/f/201512_cfpb_financial-well-being-user-guide-scale.pdf) on the survey. We will also measure change over time within individuals.
o Household income – This outcome will examine whether participants in the treatment group were more likely to increase their household income (beyond GI) compared to participants in the control group. This outcome will be measured through participants’ responses to income questions on the application and survey, as well as administrative data from the Employment Development Department (EDD). We will also measure change over time within individuals.
• Housing security
o Episode(s) of homelessness – This outcome will examine whether participants in the treatment group were less likely to experience homelessness compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about episodes of homelessness. We will also measure change over time within individuals.
o Worry about losing housing – This outcome will examine whether participants in the treatment group were less likely to worry about losing their housing compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about being worried about losing their housing. We will also measure change over time within individuals.
o Housing mobility – This outcome will examine whether participants in the treatment group moved more than participants in the control group. This outcome will be measured through participants’ responses to survey items about their living situation changes.
o Housing satisfaction – This outcome will examine whether participants in the treatment group had greater housing satisfaction than participants in the control group. This outcome will be measured through participants’ responses to survey items about their satisfaction with their living situation.
• Food insecurity – This outcome will examine whether participants in the treatment group were less likely to experience food insecurity compared to participants in the control group. This outcome will be measured through participants’ responses to the USDA short form (Blumberg et al., 1999) on the survey. We will also measure change over time within individuals.
• Employment
o Employment status – This outcome will examine whether participants in the treatment group were more likely to be employed (either full-time or part-time) compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about their employment status, as well as EDD administrative data. We will also measure change over time within individuals.
o Employment conditions – This outcome will examine whether participants in the treatment group were more likely to improve their employment compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about whether they increased their employment benefits, increased their income, and the number of jobs reported. We will also measure change over time within individuals.
o Employment mobility – This outcome will examine whether participants in the treatment group changed jobs more than participants in the control group. This outcome will be measured through participants’ responses to survey items about their job changes.
• Education
o School enrollment – This outcome will examine whether participants in the treatment group were more likely to be enrolled in school or a training program compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about their school enrollment status, as well as administrative data from the National Student Clearinghouse. We will also measure change over time within individuals.
• Participation in benefits
o Lose any benefits – This outcome will examine whether participants in the treatment group were less likely to lose any benefits compared to participants in the control group. This outcome will be measured through administrative benefits data (CalWORKs, CalFresh, MediCal, etc.).
o Gain any benefits – This outcome will examine whether participants in the treatment group were more likely to gain any new benefits compared to participants in the control group. This outcome will be measured through administrative benefits data (CalWORKs, CalFresh, MediCal, etc.).
The primary outcomes of interest for the pregnant population will be measured as follows:
• Healthcare utilization and access
o Delay or avoid healthcare – same definition as FFY
o Obtain prenatal healthcare – This outcome will examine whether participants in the treatment group were more likely to obtain prenatal healthcare compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about obtaining prenatal care, as well as through MediCal claims data and vital records data. We will also measure change over time within individuals.
• Mental health
o Depression – same definition as FFY
o Anxiety – same definition as FFY
o Perceived stress – same definition as FFY
• Financial strain and well-being
o Financial stress – same definition as FFY
o Financial well-being – same definition as FFY
o Household income – same definition as FFY
• Housing security
o Episode(s) of homelessness – same definition as FFY
o Worry about losing housing – same definition as FFY
o Housing mobility – same definition as FFY
o Housing satisfaction – same definition as FFY
• Food insecurity – same definition as FFY
• Child welfare involvement
o Maltreatment referrals – This outcome will examine whether participants in the treatment group were less likely to be referred (i.e., reported) to the child welfare system for alleged maltreatment compared to participants in the control group. This outcome will be measured through child welfare administrative data.
o Investigations – This outcome will examine whether participants in the treatment group were less likely to be investigated for alleged maltreatment compared to participants in the control group. This outcome will be measured through child welfare administrative data.
o Substantiations – This outcome will examine whether participants in the treatment group were less likely to have a substantiated (i.e., confirmed) maltreatment referral compared to participants in the control group. This outcome will be measured through child welfare administrative data.
o Case openings – This outcome will examine whether participants in the treatment group were less likely to have a child welfare case opened compared to participants in the control group. This outcome will be measured through child welfare administrative data.
• Employment
o Employment conditions – same definition as FFY
• Participation in benefits
o Lose any benefits – same definition as FFY
o Gain any benefits – same definition as FFY
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After
The primary outcomes for FFY will be measured as follows:
• Healthcare utilization and access
o Delay or avoid healthcare – This outcome will examine whether participants in the treatment group were less likely to delay or avoid healthcare due to cost or other barriers compared to participants in the control group. This outcome will be measured through participants’ responses to survey items drawn from the BRFSS (Pierannunzi, Hu, & Balluz, 2013). We will also measure change over time within individuals.
o Obtain routine healthcare – This outcome will examine whether participants in the treatment group were more likely to obtain routine healthcare compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about obtaining healthcare and also through MediCal claims data. We will also measure change over time within individuals.
• Mental health
o Depression – This outcome will examine whether participants in the treatment group were less likely to experience depression compared to participants in the control group. This outcome will be measured through participants’ responses to the PHQ-8 (Kroenke et al., 2009) on the survey. We will also measure change over time within individuals.
o Anxiety – This outcome will examine whether participants in the treatment group were less likely to experience anxiety compared to participants in the control group. This outcome will be measured through participants’ responses to the GAD-7 (Spitzer et al., 2006) on the survey. We will also measure change over time within individuals.
o Perceived stress – This outcome will examine whether participants in the treatment group were less likely to experience stress compared to participants in the control group. This outcome will be measured through participants’ responses to the PSS-4 (Karam et al., 2012) on the survey. We will also measure change over time within individuals.
• Financial strain and well-being
o Financial stress – This outcome will examine whether participants in the treatment group were less likely to experience financial stress compared to participants in the control group. This outcome will be measured through participants’ responses to the PRAMS Financial Stress instrument (https://www.cdc.gov/prams/index.htm) on the survey, specifically the question about how often they were stressed about having enough money to pay their bills. We will also measure change over time within individuals.
o Financial well-being – This outcome will examine whether participants in the treatment group were more likely to experience financial well-being compared to participants in the control group. This outcome will be measured through participants’ responses to the CFPB Financial Wellbeing instrument (https://files.consumerfinance.gov/f/201512_cfpb_financial-well-being-user-guide-scale.pdf) on the survey. We will also measure change over time within individuals.
o Household income – This outcome will examine whether participants in the treatment group were more likely to increase their household income (beyond GI) compared to participants in the control group. This outcome will be measured through participants’ responses to income questions on the application and survey, as well as administrative data from the Employment Development Department (EDD). We will also measure change over time within individuals.
• Housing security
o Episode(s) of homelessness – This outcome will examine whether participants in the treatment group were less likely to experience homelessness compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about episodes of homelessness and through HDIS administrative data. We will also measure change over time within individuals.
o Worry about losing housing – This outcome will examine whether participants in the treatment group were less likely to worry about losing their housing compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about being worried about losing their housing. We will also measure change over time within individuals.
o Housing mobility – This outcome will examine whether participants in the treatment group moved more than participants in the control group. This outcome will be measured through participants’ responses to survey items about their living situation changes.
o Housing satisfaction – This outcome will examine whether participants in the treatment group had greater housing satisfaction than participants in the control group. This outcome will be measured through participants’ responses to survey items about their satisfaction with their living situation.
• Food insecurity – This outcome will examine whether participants in the treatment group were less likely to experience food insecurity compared to participants in the control group. This outcome will be measured through participants’ responses to the USDA short form (Blumberg et al., 1999) on the survey. We will also measure change over time within individuals.
• Employment
o Employment status – This outcome will examine whether participants in the treatment group were more likely to be employed (either full-time or part-time) compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about their employment status, as well as EDD administrative data. We will also measure change over time within individuals.
o Employment conditions – This outcome will examine whether participants in the treatment group were more likely to improve their employment compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about whether they increased their employment benefits, increased their income, and the number of jobs reported. We will also measure change over time within individuals.
o Employment mobility – This outcome will examine whether participants in the treatment group changed jobs more than participants in the control group. This outcome will be measured through participants’ responses to survey items about their job changes.
• Education
o School enrollment – This outcome will examine whether participants in the treatment group were more likely to be enrolled in school or a training program compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about their school enrollment status, as well as administrative data from the National Student Clearinghouse. We will also measure change over time within individuals.
• Participation in benefits
o Lose any benefits – This outcome will examine whether participants in the treatment group were less likely to lose any benefits compared to participants in the control group. This outcome will be measured through administrative benefits data (CalWORKs, CalFresh, MediCal, etc.).
o Gain any benefits – This outcome will examine whether participants in the treatment group were more likely to gain any new benefits compared to participants in the control group. This outcome will be measured through administrative benefits data (CalWORKs, CalFresh, MediCal, etc.).
The primary outcomes of interest for the pregnant population will be measured as follows:
• Healthcare utilization and access
o Delay or avoid healthcare – same definition as FFY
o Obtain prenatal healthcare – This outcome will examine whether participants in the treatment group were more likely to obtain prenatal healthcare compared to participants in the control group. This outcome will be measured through participants’ responses to survey items about obtaining prenatal care, as well as through MediCal claims data and vital records data. We will also measure change over time within individuals.
• Mental health
o Depression – same definition as FFY
o Anxiety – same definition as FFY
o Perceived stress – same definition as FFY
• Financial strain and well-being
o Financial stress – same definition as FFY
o Financial well-being – same definition as FFY
o Household income – same definition as FFY
• Housing security
o Episode(s) of homelessness – same definition as FFY
o Worry about losing housing – same definition as FFY
o Housing mobility – same definition as FFY
o Housing satisfaction – same definition as FFY
• Food insecurity – same definition as FFY
• Child welfare involvement
o Maltreatment referrals – This outcome will examine whether participants in the treatment group were less likely to be referred (i.e., reported) to the child welfare system for alleged maltreatment compared to participants in the control group. This outcome will be measured through child welfare administrative data.
o Investigations – This outcome will examine whether participants in the treatment group were less likely to be investigated for alleged maltreatment compared to participants in the control group. This outcome will be measured through child welfare administrative data.
o Substantiations – This outcome will examine whether participants in the treatment group were less likely to have a substantiated (i.e., confirmed) maltreatment referral compared to participants in the control group. This outcome will be measured through child welfare administrative data.
o Case openings – This outcome will examine whether participants in the treatment group were less likely to have a child welfare case opened compared to participants in the control group. This outcome will be measured through child welfare administrative data.
• Employment
o Employment conditions – same definition as FFY
• Participation in benefits
o Lose any benefits – same definition as FFY
o Gain any benefits – same definition as FFY
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