1. Siouxland Social Service Utilization Study Regan Murray, Ph.D. and Todd Knealing, Ph.D. Briar Cliff University

2. Purpose of Study Primary purpose of study was to gain a better understanding of barriers to service utilization from the perspective of the consumer

3. Previous research Historically, studies have examined barriers to service utilization from the perspective of the service providers Recent research has shifted to perspective of the consumers and comparing differences between the perception of providers and consumers (e.g., Hopkins et al., 2011; Rosenheck et al., 1998) Differences in viewpoints

4. Present study Two phases to study Focus groups Surveys

5. Focus Group 1 8 participants (majority female and Caucasian) Meeting lasted 1.5 hours Focus of meeting: Names of agencies 8 questions related to participants experience with and overall impression of agencies

6. Reaction to study Im surprised anyone wants to take the time to ask us this stuff. It feels sometimes like were invisible. They [agency staff] tell us that theyre here to help us but no one really ever asks us what we think of the help. I think they just tell themselves we should be grateful for any help were given and thats that. Its kind of nice to know people actually care about this.

7. Focus Group 2 12 participants (all 8 from first group) Meeting lasted 1.5 hours Focus of meeting: Feedback on cover letter Feedback on survey

8. Survey Goal of survey was to answer the following questions: Do respondents know where to go for services in a variety of areas (e.g., medical, legal, educational) How satisfied are respondents with social service agencies in a variety of domains (e.g., ease of access, staff-consumer relations) Both general and site-specific questions

9. Survey Surveys mailed to approximately 1500 Woodbury County residents who earned less than $15,000/year Return rate ~15% 23 surveys not included in analysis Additional 208 surveys collected

10. Results: Demographics Majority of respondents were: Female (~67%) Between the ages of 26 and 35 (~28%) and over the age of 56 (~26%) Caucasian (74%) Single/never married (~38)

11. Results: Demographics Majority of respondents had children (~29% childless) Employed (~52%) Minority of respondents who were employed had health insurance (~31%) Majority of respondents earned between $5,001 and $10,000 (~51%) Majority of respondents received additional support (~52% food stamps, ~34% SS/SSD)

12. Results: Knowledge of Services Majority of respondents knew where to obtain help in a variety of domains Highest knowledge areas were for medical care, substance abuse services, mental health services, and food Lowest knowledge areas were for emergency shelter or help with child care

13. Results: Knowledge of Services Knowledge of services, however, significantly depended on both the gender and ethnicity of the respondent Males were less likely to know where to obtain all services compared to females African-Americans were less likely to know where to obtain services relative to other ethnicities

14. Results: Knowledge of Services

15. Results: Agency Satisfaction Majority of respondents had favorable opinions about the delivery of agency services. Highest ratings were in the following categories: use services again (~68%), information about my rights (~62%), and convenient location (~62%) Lowest ratings were in the following categories: receive as much help as needed (~41%), child friendly (~43%), and seen as someone worth helping (~44%)

16. Results: Agency Satisfaction Agency satisfaction results varied with ethnicity African-American respondents were less likely to be satisfied by agency service delivery compared to Caucasian respondents; this was true to a lesser extent for Hispanics Agency satisfaction results also varied with gender Males were less likely to be satisfied by agency service delivery

17. Results: Agency Satisfaction

19. Respondents comments 38% included written comments, mostly related to their experiences with social service agencies Approximately 45% of the written comments included favorable remarks about the survey and/or about agencies

20. Favorable remarks I have used many of the agencies on your list and have nothing but good things to say about them. They provided not just financial help when my family needed it, but also made me feel better about myself during a really low point in my life. Wish I didnt have to use these agencies. The people that helped me out always made me feel like I could get through the bad times and that I WOULD get back on my feet. Please tell them [listed several individual agencies] thank you.

21. Respondents comments Approximately 40% of comments were unfavorable These remarks generally could be broken down into two areas: Wasted time Problems with staff

22. Unfavorable remarks : Wasted time I know that there is always going to be lots of paperwork. I just wish I actually knew what all the forms were for. If one agency sends me to another agency for services, why do I have to repeat pretty much the exact same paperwork at the second place? Seems like these agencies should be able to share – Ill sign whatever I got to sign so they can do that. My time is valuable too. I get that the government makes us fill out these forms but I dont understand half the things Im told I need to sign. The few times that Ive asked receptionists or care workers to explain what Im signing, Ive been told not to worry about it. I dont think they knew what all the forms were for.

23. Unfavorable Remarks: Staff Just because Im poor doesnt mean Im lazy or stupid. Thats how people at some of these places treat me and my friends. Someone at [site name] asked me why I hadnt found a job and then said I probably wasnt trying hard enough. I got enough people blaming me for not working. I thought people who worked with poor people would view things a little differently. Guess I was wrong – never went back there again. I could have really used the help from them, but it wasnt worth it.

24. Respondents comments Remaining comments dont fit into any one category Ive only had to use food pantries once. Fingers crossed Ill keep my job now. Thanks for giving me a list of where I can go for help if needed later on. Im 93 and still kicking it.

25. Summary In general, most respondents reported knowing where to obtain help in a variety of domains Race and gender important factors Most respondents appeared to be satisfied with social service agencies across all domains (e.g., access, understanding of rights and rules, staff-consumer relations) Race and gender important factors

26. I mplications More outreach appears to be needed with males and African Americans to ensure that they are aware of the services available in Woodbury County Increased sensitivity to cultural and gender issues may be needed to help ensure that all consumers are being afforded the same level of care

27. Future directions Specific prescriptions for individual agencies cannot be clearly made based on present data More detailed data could be collected on specific agencies to identify relative areas of strength and weakness

28. Individual Agencies Agency directors may contact me for agency-specific information Will obtain information related to how many times your individual agency was listed and for which questions Further analysis can be done upon request