Toward a science of delivering aid with dignity: Experimental evidence and local forecasts from Kenya.

How can governments and nonprofits design aid programs that afford dignity and facilitate beneficial outcomes for recipients? We conceptualize dignity as a state that manifests when the stigma associated with receiving aid is countered and recipients are empowered, both in culturally resonant ways. Yet materials from the largest cash transfer programs in Africa predominantly characterize recipients as needy and vulnerable. Three studies examined the causal effects of alternative aid narratives on cash transfer recipients and donors. In study 1, residents of low-income settlements in Nairobi, Kenya (N = 565) received cash-based aid accompanied by a randomly assigned narrative: the default deficit-focused "Poverty Alleviation" narrative, an "Individual Empowerment" narrative, or a "Community Empowerment" narrative. They then chose whether to spend time building business skills or watching leisure videos. Both empowerment narratives improved self-efficacy and anticipated social mobility, but only the "Community Empowerment" narrative significantly motivated recipients' choice to build skills and reduced stigma. Given the diverse settings in which aid is delivered, how can organizations quickly identify effective narratives in a context? We asked recipients to predict which narrative would best motivate skill-building in their community. In study 2, this "local forecasting" methodology outperformed participant evaluations and experimental pilots in accurately ranking treatments. Finally, study 3 confirmed that the narrative most effective for recipients did not undermine donors' willingness to contribute to the program. Together these studies show that responding to recipients' psychological and sociocultural realities in the design of aid can afford recipients dignity and help realize aid's potential.

State-to-State Variation in SSI Enrollment for Children With Mental Disabilities: An Administrative and Ethical Challenge.

OBJECTIVE: The study examined state variation in rates of Supplemental Security Income (SSI) determinations, allowances, and receipt of benefits for ten selected child mental disabilities in 2013. METHODS: SSI administrative and U.S. Census Bureau data collected by a multidisciplinary consensus committee convened by the National Academies of Science, Engineering, and Medicine in 2015 were examined. RESULTS: Less than 1% of children in 2013 were recipients of SSI for mental disabilities. Determination rates ranged from 1,441 to 251 per 100,000 low-income children, an almost sixfold difference. Allowance rates varied from 16% to 78%, a fivefold difference. Receipt of benefits ranged from .7% to 5.3%, a sevenfold difference. CONCLUSIONS: Large unexplained discrepancies across states were found in review and receipt of SSI benefits for low-income children with mental disabilities. Inequities that cannot be explained by disability severity or financial need violate the ethos of equitable access to federally entitled services.

Impact and ethics of excluding sweetened beverages from the SNAP program.

The state of New York recently petitioned the US Department of Agriculture (USDA) for permission to conduct a demonstration project in which sweetened beverages would be excluded from the foods eligible to be purchased with Supplemental Assistance Nutrition Program (SNAP) benefits (i.e., food stamps) in New York City. The USDA and advocacy groups have raised objections to new SNAP restrictions such as the proposed exclusion of sweetened beverages. Some objections rest on empirical issues best resolved by demonstration projects or pilot studies of new exclusions. Other objections question the equity of excluding sweetened beverages from SNAP; these objections are important but not ethically decisive. The USDA should approve the proposed demonstration project and should encourage other pilot studies to assess the effects of excluding sweetened beverages from SNAP.

Justice and impoverished women: the ethical implications of work-based welfare.

Current U.S. welfare policy, Temporary Assistance for Needy Families, requires impoverished people to work in order to receive welfare, and it limits cash support to 5 years. Most of the people who have used this program are single-parent women, and a disturbing number have been terminated at 5 years, not having made a successful transition to work. The purpose of this longitudinal study was to explore the barriers to success and the social justice of the program from the perspective of single-parent women who were terminated. In all, 41 women were recruited through community-based purposive sampling, and the primary research methods were a qualitative, narrative interview approach and narrative analysis. Data from the semistructured interview guide are reported here. Findings describe health and socioeconomic burdens, and barriers that lie within the social policy. The study has ethical implications for nursing advocacy, and it informs nursing interventions for impoverished women and their families.

Faith-based human services initiatives: considerations for social work practice and theory.

Faith-based human services initiatives present numerous challenges to professional social work. This article explores ways a theoretical integration of ecosystems and structuration perspectives may help social workers navigate complex ideological and practical implications of changing service delivery policies. The article highlights diversity among faith-related providers, with presentation of a services typology relevant to social work and ethical guidelines to inform decision making regarding referrals and collaborations. Examples from a qualitative study of faith-related services, values, and practices illustrate the typology and related practice issues.