Does psycho-social support to the chronically poor reduce poverty?


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Psycho-social well-being is a catch-all term that encompasses both psychological and social dimensions of life. This broad domain of welfare is typically correlated with traditional poverty measures – the economic poor also often exhibit low levels of psycho-social health and functioning. But does this correlation capture a causal relation running from low levels of psycho-social health to poverty? And, if so, can intervening in the psycho-social domain reduce poverty?

There are precious few impact evaluations that test the influence of psycho-social interventions on economic behavior or poverty reduction. (One relatively little known RCT study from the U.S. finds that successfully treating depression increases labor force participation by twenty percentage points!) Well now an evaluation of Chile Solidario, an innovative anti-poverty program from (as you might guess) Chile, is adding to this literature.

Chile Solidario adopts an integrated approach to poverty reduction and is targeted to the roughly 4% of the Chilean population deemed living in extreme poverty. The program combines information, skill-development, and psycho-social support delivered through a social worker. The program also transfers a small amount of cash meant to compensate for the transactions costs incurred by households when enrolling in social services. The motivating idea behind the program is to instill confidence and build the necessary social tools so the indigent poor can access existing social services and seek employment programs and occupational training. Increased access was the first order goal of the program since many of Chile’s indigent poor do not participate in the existing poverty programs for which they are the intended beneficiaries.

Pedro Carneiro, Emanuela Galasso, and Rita Ginja have evaluated the impacts of Chile Solidario. The first summary results can be found in this short policy note and a multitude of initial findings are in this report.

The authors use both administrative and specially collected survey data to look across a range of outcomes. The causal impacts of the program are estimated with a regression discontinuity design (RDD). A well-known interpretive difficulty with RD D is that it identifies program effects around the discontinuity created by eligibility rules but may not have much validity for the program effects on populations further from the eligibility cut-off. In this case, since the eligibility cut-offs were municipality specific and varied widely around the country, worries with generalizability are less of a concern.

Taken all together, the program increases the uptake of the various subsidy programs available to poor households in Chile. This increased access translates most directly into improvements in the quality of housing as well as in formal ownership of housing. Program participants also become more optimistic about the future and younger households are less likely to experience family dissolution. However other psycho-social measures such as self-efficacy show little improvement.

There doesn’t appear to be much effect on employment and earnings of the household head but this may be because the head, especially if the head is male, is already economically active. However there are significant gains in the employment and earnings of secondary household members and in particular gains for the spouse of the head.

Taken overall, Chile Solidario appears to have been successful in certain dimensions but, as the authors state, much more analysis and work is to come. We will invite Pedro, Emanuela, and Rita to blog about various aspects of this work in more detail, so hopefully you will hear directly from them soon!




Jed Friedman

Senior Economist, Development Research Group, World Bank

Join the Conversation

Amanda Glassman
August 10, 2011

For design reasons, this evaluation actually can't answer the question that you are posing, no? There is the suggestive finding that better outcomes are associated with being assigned a case worker with a lower case load, but beyond that? This is an important question since all that counseling is expensive and its relationship to outcomes is unknown.

(p.s. - is it a good idea to cite Lagos in the brief on the evaluation if you want results to be used by new government??)

Jed Friedman
August 10, 2011

Amanda, thanks for the thoughtful comments. Yes Chile Solidario is a package of interventions. While the summary results cannot attribute causality to any sole component, the psycho-social aspect is a central feature of the program. Presumably the social workers are providing something and since those with low caseloads are more effective, it is likely that the benefit is not merely informational.

The point is that there is little evidence on the effectiveness of this broad class of interventions, so here is one example, even if it imperfectly speaks to the question at hand. And I am sure that the various results will be analyzed in more detail to give us a fuller picture and possibly help us understand the causal channels. I very much agree that cost-effectiveness is a critical question.

Susan D. Einbinder
August 11, 2011

I've been a social work professor for 20 years now, and, although I have not been conducted poverty -reduction research for a while, I think that there's a useful parallel, or sorts, from social work research investigating Family Preservation (FP)in foster care, which was introduced in the 1980s by two social workers in Washington state: Their program assigned one social worker to two families - only - but the social worker was available and 'on call' 24 hours a day, 7 days a week, for six months, to help with whatever problems had arisen to put the child(ren) in the family "at risk" for foster care placement. Funds that had been restricted to a few uses only (therapy, job training) were pooled and could be used for anything - repairing the house, getting the car fixed, etc., etc. Social workers loved it, since carrying 2 cases was a whole lot better than carrying 24 - or 32, depending on how badly their department was funded. And they got to interact on a very intimate basis with the family, likely "feeling" like they were making and difference (which they very likely may have done, although colored by socioeconomic and likely cultural differences).

Initial results were extraordinary: it appeared that Family Preservation prevented foster care placement. The model was adopted and modified all over the country, hailed as a solution to foster care place for the subset of cases that could be "treated" with this new modality. Of course, serious cases - child abuse - were not permitted in this model. Eventually, Title IV-E funds were authorized by DHHS to subsidize this new approach, and it's available - although not universally - everywhere. Everyone thinks it is cheaper and better.

Fast forward 20+ years, though, and in ... the mid-90s, three (or more?) studies were published that had evaluated Family Preservation over the long haul.

Ends up, FP postpones foster care placement - it doesn't prevent it permanently. Having a full-time social worker around helps put the family back together again - for a time. But eventually, that facade cracks and the family has serious troubles again.

Most (extremely poor) families who come to the attention of the Department of Children and Family Services (or whatever its name - in CA it's a county-level mandated service that investigates every single anonymous allegation of child maltreatment and has the authority to remove the child from the home) have had a long history of difficulties exacerbated (if not caused) by economic deprivation.

So the population here is slightly different than the one in Chile - these are families with one or more dependent children, who are mandated to be in the program. That's different than welfare recipients or job-training enrollees, etc., etc. although there's quite a bit of overlap.

For the families who had been in FP, the child maltreatment allegation indicated a serious crisis - and once the crisis abated, things went back to normal - until the next crisis took place. The 'usual' crisis was a new baby, lost job, divorce, or death of a parent, by the way - the kind of crisis that causes stress to anyone, but absent any financial cushioning, and often missing social support as well, it is often far worse for the parent, who - let me be clear here as this is the official position and not mine - then subjects the child to treatment that impairs his/her well-being.

So FP (aided by the internal validity threat of regression) itself is not sufficient to reverse or prevent economic difficulties that present as child maltreatment.

Child maltreatment includes an absence of sufficient care (neglect, which characterizes the majority of cases, about 70 percent, I think) or the preponderance of the 'wrong' kind of care, which is one or a combination of physical, sexual and emotional abuse.

There were a few studies in the 1990s that actually asked poor people what they need to get themselves out of poverty: As you can imagine, none of them asked for social workers or counseling services.

Poor people want, in the order recounted, well-paying jobs, affordable housing, and decent schools for their kids.

The irony of social work - my chosen profession - is that we've created another layer of employment for social workers, who then 'help' poor people, who would prefer to have their jobs.

Don't underestimate the social value of creating social work jobs, though.

I think that poor people who much prefer getting money than social services - wouldn't you?


Jed Friedman
August 12, 2011

... this is an area I am just learning about so I very much value your comment. From the perspective of impact evaluation more generally, this seems a good example of how a different time span of observation can yield very different policy lessons..

Rachel Kasumba
November 18, 2011

With civil and mass unrest on the rise in many parts of the world, the effects of social services or welfare provision to the poor or poorest members of society is under scrutiny by a lot of policy makers. Economic growth in the West has stagnated while picking up in emerging markets and it is presenting challenges in both worlds.

In the developed countries, the poor of the poorest who had grown dependent on social welfare are losing most of these benefits due to increase in unemployment (less tax revenue to support poor yet there are more people in need of this limited welfare) rates, population aging (more people competing for social welfare), infrastructure and real estate aging (so money that would have been devoted to welfare diverted), etc Another hitherto unforeseen competitor for these dwindling resources is overseas donations and loans to bail out poor countries. National debt especially among the wealthiest/most generous donors is also rising, further eating into funds that would have gone to helping the ones in dire need!

In emerging markets, the challenges are mainly as a result of rapid industrialization that has led to a steep rise in rural urban migration. Congestion in the cities and other urban centers has fueled unprecedented levels of crime, poverty rates, and a strain on existing infrastructure. It has also led to high ambitions among the recent arrivals who view the elite and moneyed with suspicion which has led to widespread unrest. The poor are "rubbing" shoulders with the rich within very close proximity as they work side by side and the former feel that they are being left behind on the bridge to progress which causes resentment. The availability of technology (radios, communal television, mobile phones, internet services, etc), conspicuous consumption of the middle and upper classes, widespread idleness, in these urban centers have all contributed to the rising aspirations of the poor and poorest.

As you can see, social workers and organizations and the effectiveness of the services that they offer has to be re-invented in line with the current "new" needs of the poor really are! As Susan discussed above, the poor are more interested in getting money than social services. I believe it is in the interest of everybody to get those who are able and willing to work or engage in self-employment, ready (via education, skills training, etc as highlighted by Jed). Self-reliance pursuit has now become the name of the game and social services providers have to revamp the ways and means of how they have traditionally approached helping the less fortunate.

Policy makers will benefit greatly by utilizing the immense body of already existing work, studies, observations, and analysis of teams like Jeds' to help steer the poor and poorest on the path to economic empowerment.