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The Effects of a Supported Employment Program on Psychosocial Indicators

for Persons with Severe Mental Illness

William M.K. Trochim

Cornell University

Running Head: SUPPORTED EMPLOYMENT


Abstract

This paper describes the psychosocial effects of a program of supported employment (SE) for persons with severe mental illness. The SE program involves extended individualized supported employment for clients through a Mobile Job Support Worker (MJSW) who maintains contact with the client after job placement and supports the client in a variety of ways. A 50% simple random sample was taken of all persons who entered the Thresholds Agency between 3/1/93 and 2/28/95 and who met study criteria. The resulting 484 cases were randomly assigned to either the SE condition (treatment group) or the usual protocol (control group) which consisted of life skills training and employment in an in-house sheltered workshop setting. All participants were measured at intake and at 3 months after beginning employment, on two measures of psychological functioning (the BPRS and GAS) and two measures of self esteem (RSE and ESE). Significant treatment effects were found on all four measures, but they were in the opposite direction from what was hypothesized. Instead of functioning better and having more self esteem, persons in SE had lower functioning levels and lower self esteem. The most likely explanation is that people who work in low-paying service jobs in real world settings generally do not like them and experience significant job stress, whether they have severe mental illness or not. The implications for theory in psychosocial rehabilitation are considered.


The Effects of a Supported Employment Program on Psychosocial Indicators for Persons with Severe Mental Illness

Over the past quarter century a shift has occurred from traditional institution-based models of care for persons with severe mental illness (SMI) to more individualized community-based treatments. Along with this, there has been a significant shift in thought about the potential for persons with SMI to be "rehabilitated" toward lifestyles that more closely approximate those of persons without such illness. A central issue is the ability of a person to hold a regular full-time job for a sustained period of time. There have been several attempts to develop novel and radical models for program interventions designed to assist persons with SMI to sustain full-time employment while living in the community. The most promising of these have emerged from the tradition of psychiatric rehabilitation with its emphases on individual consumer goal setting, skills training, job preparation and employment support (Cook, Jonikas and Solomon, 1992). These are relatively new and field evaluations are rare or have only recently been initiated (Cook and Razzano, 1992; Cook, 1992). Most of the early attempts to evaluate such programs have naturally focused almost exclusively on employment outcomes. However, theory suggests that sustained employment and living in the community may have important therapeutic benefits in addition to the obvious economic ones. To date, there have been no formal studies of the effects of psychiatric rehabilitation programs on key illness-related outcomes. To address this issue, this study seeks to examine the effects of a new program of supported employment on psychosocial outcomes for persons with SMI.

Over the past several decades, the theory of vocational rehabilitation has experienced two major stages of evolution. Original models of vocational rehabilitation were based on the idea of sheltered workshop employment. Clients were paid a piece rate and worked only with other individuals who were disabled. Sheltered workshops tended to be "end points" for persons with severe and profound mental retardation since few ever moved from sheltered to competitive employment (Woest, Klein & Atkins, 1986). Controlled studies of sheltered workshop performance of persons with mental illness suggested only minimal success (Griffiths, 1974) and other research indicated that persons with mental illness earned lower wages, presented more behavior problems, and showed poorer workshop attendance than workers with other disabilities (Whitehead, 1977; Ciardiello, 1981).

In the 1980s, a new model of services called Supported Employment (SE) was proposed as less expensive and more normalizing for persons undergoing rehabilitation (Wehman, 1985). The SE model emphasizes first locating a job in an integrated setting for minimum wage or above, and then placing the person on the job and providing the training and support services needed to remain employed (Wehman, 1985). Services such as individualized job development, one-on-one job coaching, advocacy with co-workers and employers, and "fading" support were found to be effective in maintaining employment for individuals with severe and profound mental retardation (Revell, Wehman & Arnold, 1984). The idea that this model could be generalized to persons with all types of severe disabilities, including severe mental illness, became commonly accepted (Chadsey-Rusch & Rusch, 1986).

One of the more notable SE programs was developed at Thresholds, the site for the present study, which created a new staff position called the mobile job support worker (MJSW) and removed the common six month time limit for many placements. MJSWs provide ongoing, mobile support and intervention at or near the work site, even for jobs with high degrees of independence (Cook & Hoffschmidt, 1993). Time limits for many placements were removed so that clients could stay on as permanent employees if they and their employers wished. The suspension of time limits on job placements, along with MJSW support, became the basis of SE services delivered at Thresholds.

There are two key psychosocial outcome constructs of interest in this study. The first is the overall psychological functioning of the person with SMI. This would include the specification of severity of cognitive and affective symptomotology as well as the overall level of psychological functioning. The second is the level of self-reported self esteem of the person. This was measured both generally and with specific reference to employment.

The key hypothesis of this study is:

HO: A program of supported employment will result in either no change or negative effects on psychological functioning and self esteem.

which will be tested against the alternative:

HA: A program of supported employment will lead to positive effects on psychological functioning and self esteem.

Method

Sample

The population of interest for this study is all adults with SMI residing in the U.S. in the early 1990s. The population that is accessible to this study consists of all persons who were clients of the Thresholds Agency in Chicago, Illinois between the dates of March 1, 1993 and February 28, 1995 who met the following criteria: 1) a history of severe mental illness (e.g., either schizophrenia, severe depression or manic-depression); 2) a willingness to achieve paid employment; 3) their primary diagnosis must not include chronic alcoholism or hard drug use; and 4) they must be 18 years of age or older. The sampling frame was obtained from records of the agency. Because of the large number of clients who pass through the agency each year (e.g., approximately 500 who meet the criteria) a simple random sample of 50% was chosen for inclusion in the study. This resulted in a sample size of 484 persons over the two-year course of the study.

On average, study participants were 30 years old and high school graduates (average education level = 13 years). The majority of participants (70%) were male. Most had never married (85%), few (2%) were currently married, and the remainder had been formerly married (13%). Just over half (51%) are African American, with the remainder Caucasian (43%) or other minority groups (6%). In terms of illness history, the members in the sample averaged 4 prior psychiatric hospitalizations and spent a lifetime average of 9 months as patients in psychiatric hospitals. The primary diagnoses were schizophrenia (42%) and severe chronic depression (37%). Participants had spent an average of almost two and one-half years (29 months) at the longest job they ever held.

While the study sample cannot be considered representative of the original population of interest, generalizability was not a primary goal -- the major purpose of this study was to determine whether a specific SE program could work in an accessible context. Any effects of SE evident in this study can be generalized to urban psychiatric agencies that are similar to Thresholds, have a similar clientele, and implement a similar program.

Measures

All but one of the measures used in this study are well-known instruments in the research literature on psychosocial functioning. All of the instruments were administered as part of a structured interview that an evaluation social worker had with study participants at regular intervals.

Two measures of psychological functioning were used. The Brief Psychiatric Rating Scale (BPRS)(Overall and Gorham, 1962) is an 18-item scale that measures perceived severity of symptoms ranging from "somatic concern" and "anxiety" to "depressive mood" and "disorientation." Ratings are given on a 0-to-6 Likert-type response scale where 0="not present" and 6="extremely severe" and the scale score is simply the sum of the 18 items. The Global Assessment Scale (GAS)(Endicott et al, 1976) is a single 1-to-100 rating on a scale where each ten-point increment has a detailed description of functioning (higher scores indicate better functioning). For instance, one would give a rating between 91-100 if the person showed "no symptoms, superior functioning..." and a value between 1-10 if the person "needs constant supervision..."

Two measures of self esteem were used. The first is the Rosenberg Self Esteem (RSE) Scale (Rosenberg, 1965), a 10-item scale rated on a 6-point response format where 1="strongly disagree" and 6="strongly agree" and there is no neutral point. The total score is simply the sum across the ten items, with five of the items being reversals. The second measure was developed explicitly for this study and was designed to measure the Employment Self Esteem (ESE) of a person with SMI. This is a 10-item scale that uses a 4-point response format where 1="strongly disagree" and 4="strongly agree" and there is no neutral point. The final ten items were selected from a pool of 97 original candidate items, based upon high item-total score correlations and a judgment of face validity by a panel of three psychologists. This instrument was deliberately kept simple -- a shorter response scale and no reversal items -- because of the difficulties associated with measuring a population with SMI. The entire instrument is provided in Appendix A.

All four of the measures evidenced strong reliability and validity. Internal consistency reliability estimates using Cronbach's alpha ranged from .76 for ESE to .88 for SE. Test-retest reliabilities were nearly as high, ranging from .72 for ESE to .83 for the BPRS. Convergent validity was evidenced by the correlations within construct. For the two psychological functioning scales the correlation was .68 while for the self esteem measures it was somewhat lower at .57. Discriminant validity was examined by looking at the cross-construct correlations which ranged from .18 (BPRS-ESE) to .41 (GAS-SE).

Design

A pretest-posttest two-group randomized experimental design was used in this study. In notational form, the design can be depicted as:

R O X O

R O O

where:

R = the groups were randomly assigned

O = the four measures (i.e., BPRS, GAS, RSE, and ESE)

X = supported employment

The comparison group received the standard Thresholds protocol which emphasized in-house training in life skills and employment in an in-house sheltered workshop. All participants were measured at intake (pretest) and at three months after intake (posttest).

This type of randomized experimental design is generally strong in internal validity. It rules out threats of history, maturation, testing, instrumentation, mortality and selection interactions. Its primary weaknesses are in the potential for treatment-related mortality (i.e., a type of selection-mortality) and for problems that result from the reactions of participants and administrators to knowledge of the varying experimental conditions. In this study, the drop-out rate was 4% (N=9) for the control group and 5% (N=13) in the treatment group. Because these rates are low and are approximately equal in each group, it is not plausible that there is differential mortality. There is a possibility that there were some deleterious effects due to participant knowledge of the other group's existence (e.g., compensatory rivalry, resentful demoralization). Staff were debriefed at several points throughout the study and were explicitly asked about such issues. There were no reports of any apparent negative feelings from the participants in this regard. Nor is it plausible that staff might have equalized conditions between the two groups. Staff were given extensive training and were monitored throughout the course of the study. Overall, this study can be considered strong with respect to internal validity.

Procedure

Between 3/1/93 and 2/28/95 each person admitted to Thresholds who met the study inclusion criteria was immediately assigned a random number that gave them a 50/50 chance of being selected into the study sample. For those selected, the purpose of the study was explained, including the nature of the two treatments, and the need for and use of random assignment. Participants were assured confidentiality and were given an opportunity to decline to participate in the study. Only 7 people (out of 491) refused to participate. At intake, each selected sample member was assigned a random number giving them a 50/50 chance of being assigned to either the Supported Employment condition or the standard in-agency sheltered workshop. In addition, all study participants were given the four measures at intake.

All participants spent the initial two weeks in the program in training and orientation. This consisted of life skill training (e.g., handling money, getting around, cooking and nutrition) and job preparation (employee roles, coping strategies). At the end of that period, each participant was assigned to a job site -- at the agency sheltered workshop for those in the control condition, and to an outside employer if in the Supported Employment group. Control participants were expected to work full-time at the sheltered workshop for a three-month period, at which point they were posttested and given an opportunity to obtain outside employment (either Supported Employment or not). The Supported Employment participants were each assigned a case worker -- called a Mobile Job Support Worker (MJSW) -- who met with the person at the job site two times per week for an hour each time. The MJSW could provide any support or assistance deemed necessary to help the person cope with job stress, including counseling or working beside the person for short periods of time. In addition, the MJSW was always accessible by cellular telephone, and could be called by the participant or the employer at any time. At the end of three months, each participant was post-tested and given the option of staying with their current job (with or without Supported Employment) or moving to the sheltered workshop.

Results

There were 484 participants in the final sample for this study, 242 in each treatment. There were 9 drop-outs from the control group and 13 from the treatment group, leaving a total of 233 and 229 in each group respectively from whom both pretest and posttest were obtained. Due to unexpected difficulties in coping with job stress, 19 Supported Employment participants had to be transferred into the sheltered workshop prior to the posttest. In all 19 cases, no one was transferred prior to week 6 of employment, and 15 were transferred after week 8. In all analyses, these cases were included with the Supported Employment group (intent-to-treat analysis) yielding treatment effect estimates that are likely to be conservative.

The major results for the four outcome measures are shown in Figure 1.

_______________________________________

Insert Figure 1 about here

_______________________________________

It is immediately apparent that in all four cases the null hypothesis has to be accepted -- contrary to expectations, Supported Employment cases did significantly worse on all four outcomes than did control participants.

The mean gains, standard deviations, sample sizes and t-values (t-test for differences in average gain) are shown for the four outcome measures in Table 1.

_______________________________________

Insert Table 1 about here

_______________________________________

The results in the table confirm the impressions in the figures. Note that all t-values are negative except for the BPRS where high scores indicate greater severity of illness. For all four outcomes, the t-values were statistically significant (p<.05).

Conclusions

The results of this study were clearly contrary to initial expectations. The alternative hypothesis suggested that SE participants would show improved psychological functioning and self esteem after three months of employment. Exactly the reverse happened -- SE participants showed significantly worse psychological functioning and self esteem.

There are two major possible explanations for this outcome pattern. First, it seems reasonable that there might be a delayed positive or "boomerang" effect of employment outside of a sheltered setting. SE cases may have to go through an initial difficult period of adjustment (longer than three months) before positive effects become apparent. This "you have to get worse before you get better" theory is commonly held in other treatment-contexts like drug addiction and alcoholism. But a second explanation seems more plausible -- that people working full-time jobs in real-world settings are almost certainly going to be under greater stress and experience more negative outcomes than those who work in the relatively safe confines of an in-agency sheltered workshop. Put more succinctly, the lesson here might very well be that work is hard. Sheltered workshops are generally very nurturing work environments where virtually all employees share similar illness histories and where expectations about productivity are relatively low. In contrast, getting a job at a local hamburger shop or as a shipping clerk puts the person in contact with co-workers who may not be sympathetic to their histories or forgiving with respect to low productivity. This second explanation seems even more plausible in the wake of informal debriefing sessions held as focus groups with the staff and selected research participants. It was clear in the discussion that SE persons experienced significantly higher job stress levels and more negative consequences. However, most of them also felt that the experience was a good one overall and that even their "normal" co-workers "hated their jobs" most of the time.

One lesson we might take from this study is that much of our contemporary theory in psychiatric rehabilitation is naive at best and, in some cases, may be seriously misleading. Theory led us to believe that outside work was a "good" thing that would naturally lead to "good" outcomes like increased psychological functioning and self esteem. But for most people (SMI or not) work is at best tolerable, especially for the types of low-paying service jobs available to study participants. While people with SMI may not function as well or have high self esteem, we should balance this with the desire they may have to "be like other people" including struggling with the vagaries of life and work that others struggle with.

Future research in this are needs to address the theoretical assumptions about employment outcomes for persons with SMI. It is especially important that attempts to replicate this study also try to measure how SE participants feel about the decision to work, even if traditional outcome indicators suffer. It may very well be that negative outcomes on traditional indicators can be associated with a "positive" impact for the participants and for the society as a whole.


References

Chadsey-Rusch, J. and Rusch, F.R. (1986). The ecology of the workplace. In J. Chadsey-Rusch, C. Haney-Maxwell, L. A. Phelps and F. R. Rusch (Eds.), School-to-Work Transition Issues and Models. (pp. 59-94), Champaign IL: Transition Institute at Illinois.

Ciardiello, J.A. (1981). Job placement success of schizophrenic clients in sheltered workshop programs. Vocational Evaluation and Work Adjustment Bulletin, 14, 125-128, 140.

Cook, J.A. (1992). Job ending among youth and adults with severe mental illness. Journal of Mental Health Administration, 19(2), 158-169.

Cook, J.A. & Hoffschmidt, S. (1993). Psychosocial rehabilitation programming: A comprehensive model for the 1990's. In R.W. Flexer and P. Solomon (Eds.), Social and Community Support for People with Severe Mental Disabilities: Service Integration in Rehabilitation and Mental Health. Andover, MA: Andover Publishing.

Cook, J.A., Jonikas, J., & Solomon, M. (1992). Models of vocational rehabilitation for youth and adults with severe mental illness. American Rehabilitation, 18, 3, 6-32.

Cook, J.A. & Razzano, L. (1992). Natural vocational supports for persons with severe mental illness: Thresholds Supported Competitive Employment Program, in L. Stein (ed.), New Directions for Mental Health Services, San Francisco: Jossey-Bass, 56, 23-41.

Endicott, J.R., Spitzer, J.L. Fleiss, J.L. and Cohen, J. (1976). The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766-771.

Griffiths, R.D. (1974). Rehabilitation of chronic psychotic patients. Psychological Medicine, 4, 316-325.

Overall, J. E. and Gorham, D. R. (1962). The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799-812.

Rosenberg, M. (1965). Society and Adolescent Self Image. Princeton, NJ, Princeton University Press.

Wehman, P. (1985). Supported competitive employment for persons with severe disabilities. In P. McCarthy, J. Everson, S. Monn & M. Barcus (Eds.), School-to-Work Transition for Youth with Severe Disabilities, (pp. 167-182), Richmond VA: Virginia Commonwealth University.

Whitehead, C.W. (1977). Sheltered Workshop Study: A Nationwide Report on Sheltered Workshops and their Employment of Handicapped Individuals. (Workshop Survey, Volume 1), U.S. Department of Labor Service Publication. Washington, DC: U.S. Government Printing Office.

Woest, J., Klein, M. and Atkins, B.J. (1986). An overview of supported employment strategies. Journal of Rehabilitation Administration, 10(4), 130-135.


Table 1. Means, standard deviations and Ns for the pretest, posttest and gain scores for the four outcome variables and t-test for difference between average gains.

BPRSPretestPosttestGain
TreatmentMean3.25.1 1.9
sd 2.42.72.55
N 229229229
ControlMean3.43.0 -0.4
sd 2.32.52.4
N 233233233
t =9.979625p<.05
GASPretestPosttestGain
TreatmentMean5943 -16
sd 25.224.324.75
N 229229229
ControlMean6163 2
sd 26.722.124.4
N 233233233
t = -7.87075p<.05
RSEPretestPosttestGain
TreatmentMean4231 -11
sd 27.126.526.8
N 229229229
ControlMean4143 2
sd 28.225.927.05
N 233233233
t = -5.1889p<.05
ESEPretestPosttestGain
TreatmentMean2716 -11
sd 19.321.220.25
N 229229229
ControlMean2524 -1
sd 18.620.319.45
N 233233233
t = -5.41191p<.05

Figure 1. Pretest and posttest means for treatment (SE) and control groups for the four outcome measures.





Appendix A

The Employment Self Esteem Scale

Please rate how strongly you agree or disagree with each of the following statements.


StronglyDisagree


SomewhatDisagree


SomewhatAgree


StronglyAgree

1. I feel good about my work on the job.


StronglyDisagree


SomewhatDisagree


SomewhatAgree


StronglyAgree

2. On the whole, I get along well with others at work.


StronglyDisagree


SomewhatDisagree


SomewhatAgree


StronglyAgree

3. I am proud of my ability to cope with difficulties at work.


StronglyDisagree


SomewhatDisagree


SomewhatAgree


StronglyAgree

4. When I feel uncomfortable at work, I know how to handle it.


StronglyDisagree


SomewhatDisagree


SomewhatAgree


StronglyAgree

5. I can tell that other people at work are glad to have me there.


StronglyDisagree


SomewhatDisagree


SomewhatAgree


StronglyAgree

6. I know I'll be able to cope with work for as long as I want.


StronglyDisagree


SomewhatDisagree


SomewhatAgree


StronglyAgree

7. I am proud of my relationship with my supervisor at work.


StronglyDisagree


SomewhatDisagree


SomewhatAgree


StronglyAgree

8. I am confident that I can handle my job without constant assistance.


StronglyDisagree


SomewhatDisagree


SomewhatAgree


StronglyAgree

9. I feel like I make a useful contribution at work.


StronglyDisagree


SomewhatDisagree


SomewhatAgree


StronglyAgree

10. I can tell that my co-workers respect me.

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Copyright ©2006, William M.K. Trochim, All Rights Reserved
Purchase a printed copy of the Research Methods Knowledge Base
Last Revised: 10/20/2006

Women today remain disadvantaged in the work environment and socially compared to men even though women are now legally equal to men in most aspects in most countries, glaring inequality still remains in a key area, parenting. Traditionally, a woman’s role in society was to raise her children, care for her husband and look after the household. This cultural expectation broadly remains intact today despite large steps toward gender equality taken in other areas of life. It is reflected both in our culture and in law. Women are allowed and usually expected to work, but if they also have a family which in itself is another strong social expectation they have to also take on this second job at home.

Feminist academic Arlie Hochschild popularized this concept with her 1989 book The Second Shift: Working Parents and the Revolution at Home. She describes what she calls the “second shift”, referring to this unpaid domestic labor.  Hochschild and her team interviewed fifty couples for the book throughout the 1970s and ‘80s, to find the different loads of child care and housework shared by the couples and measure the “leisure gap” between them (the difference in the amount of free time left over each week after work, child, household and personal care duties.)

What she found, unsurprisingly, was that wives disproportionately undertook the domestic labor that makes up the second shift, but because of the large scale entry of women into the workplace throughout the 20th century this wasn’t a clear cut or universal practice. Hochschild placed each family she studied into one of three categories: traditional, egalitarian and transitional. Since the problem is a structural one and can’t just be wished away, these married couples had to have some kind of way to manage their home lives. Who does what tasks? Do they share them, and if so how much? Is the gendered division of labor satisfactory for both parties, or are there tensions and conflicts in the relationship because of them?

In “traditional” families, the wife and mother took on all of the cooking, cleaning and nurturing the children, basically living up to the idealized picture of proper womanhood, being a hausfrau. Men at work, women at home. These families were a minority, surprisingly given how widespread the image is. It was more popular with the working class families she studied than with more affluent ones.

In “egalitarian” households, both partners felt that they should share domestic responsibilities as much as possible. Husbands should be fathers just as much as they’re providers, and wives should be career-oriented as much as they’re family-oriented. Egalitarian arrangements were also a minority. “Transitional” households had blending between the two poles, to different degrees. The wife shouldn’t be homebound but should still do the majority of the domestic work, though the husband has a role in it too. This arrangement was the most popular.

The three approaches weren’t necessarily decided by explicit consent; more often the spouses just “fell into” these roles as an unconscious or unspoken act. Couples also didn’t necessarily agree on which ideological position to take, and disagreements on fulfilling or subverting gender norms were sources of serious marital conflict.

Hochschild wrote that our situation was a “stalled revolution.” Even though women had broken into the work force and were advancing upward from the lowest-paid professions steadily suggested a combination of both government policies and changing cultural attitudes to fix the problem. In an interview conducted 25 years after publishing The Second Shift, she regretfully noted that these government policies haven’t materialized yet. She noted several things that made the position of American workers less favorable to women compared to other countries. U.S. employees work long hours and with less flex time, which hurts workers in caregiver roles, mainly women. Most other high-income countries, not just the Scandinavian welfare states, have paid parental leave. We don’t have government subsidized child care – “even talking about government help seems more like a pipedream now.” She says that the added pressure on wages and employment is hurting not just blue collar workers, but also white collar workers and workers’ families. She acknowledges the spreading of female upward mobility that has brought many female managers and CEOs, but says that overall, we have now hit a second stall in the stalled revolution.

Arlie Hochschild’s most widely read works appeared during a transitional period between two periods in the development of the feminist movement, second-wave feminism and third-wave feminism. Third-wave feminism, which started in the early 1990s, put more focus on challenging and deconstructing gender roles than in the second wave that was more focused on rights. Although she was very influential, Hoschschild wasn’t the first prominent thinker to pay attention to gender relations in the workplace.

Alexandra Kollontai was one such figure from the early 20th century,  a Russian revolutionary who was the main women’s theorist and activist in the Russian Communist Party. Like other Bolsheviks, she saw social issues through the lens of class, and she produced a large body of material on issues specific to working class women. She called the unequal share of domestic labor the double burden instead of the second shift, but it was the same problem they were both describing. The difference between them comes from Kollontai’s looking at the class dynamics. Working class women (women who work for a wage and don’t own their own business or productive land) don’t share the same interests as “middle class” (petty-bourgeois) and bourgeois women. Hochschild found that working class women were more likely to be “traditional” housewives – Kollontai would explain this as them lacking access to nannies and other kinds of hired help. Her view was that in pre-capitalist, feudal society, female-based home child care was necessary because the household was the main productive economic unit. Peasant families tended their own small plots or a parcel from a landlord to grow food. Under capitalism though, this was no longer needed because the household is now a unit of consumption. Its continued existence oppressed women, so child care needed to be taken out of the private sphere and put into the public sphere:

“A labour state establishes a completely new principle: care of the younger generation is not a private family affair, but a social-state concern. Maternity is protected and provided for not only in the interests of the woman herself, but still more in the interests of the tasks before the national economy during the transition to a socialist system: it is necessary to save women from an unproductive expenditure of energy on the family so that this energy can be used efficiently in the interests of the collective; it is necessary to protect their health in order to guarantee the labour republic a flow of healthy workers in the future.

In the bourgeois state it is not possible to pose the question of maternity in this way: class contradictions and the lack of unity between the interests of private economies and the national economy hinder this. In a labour republic, on the other hand, where the individual economies are dissolving into the general economy and where classes are disintegrating and disappearing, such a solution to the question of maternity is demanded by life, by necessity. The labour republic sees woman first and foremost as a member of the labour force, as a unit of living labour; the function of maternity is seen as highly important, but as a supplementary task and as a task that is not a private family matter but a social matter.”1

Kollontai knew this transfer of the domestic burden from the individual level to the social level wouldn’t happen overnight, but thought it had to be taken on consciously and that gender equality wasn’t an automatic process. She actually had to fight with some other prominent Communist leaders on this, who thought that women’s emancipation would happen more or less automatically under socialism. Kollontai successfully agitated for creating the Department of Mother and Child in the new Soviet government, which introduced creches, canteens and public laundry facilities, either from building new ones or taking the few existing facilities into state ownership. With Yakov Sverdlov, she drafted the 1918 law on marriage, family and guardianship that legalized civil marriage, no-fault divorce, and abortion.2

She also initiated and lead the Zhenotdel (Women’s Department) of the Bolshevik Party itself. One of its jobs was to make sure the new laws were actually implemented, which frequently only existed on paper. Soviet Russia inherited a lot of economic and cultural backwardness from the Russian Empire, and fighting in World War I followed by the Russian Civil War only made things worse. The Zhenotdel was unpopular among some factory managers, government departments and union activists, seen as a nuisance. Kollontai resigned her leadership role after suffering a heart attack, and the Zhenotdel’s role was diminished year by year until it was shut down by Joseph Stalin in 1930.

A lot has changed since 1920s, or even since 1989, but women are still widely disadvantaged by the same economic setup. The share of domestic labor in households has evened out more in the past twenty years in the United States but it still falls more on women than men. This effects women very sharply in terms of wages. Since overtime work is an important way to bring in more money, women’s decreased ability to work overtime because of domestic commitments hits hard.

According to a study released by the Department of Sociology at Indiana University3, the percentage of American male workers who worked 50 hours or more per week was 19%, while for women it was 7%. Women were less likely to take or keep a job that required overtime work. Employers often encourage 24/7 availability, which is also helped by how common instant, round-the-clock communication is today. The economy overall is trending more toward longer work hours and more compensation for overwork (and employers are increasingly willing to have more pay disparity within the same workplace), so this difference has the effect of counteracting trends toward gendered wage equity. The authors, Youngjoo Cha and Kim Weeden, dismiss claims that this is because women just want fewer working hours than their male counterparts. Instead, they point to multiple studies that explain the gender disparity in overtime in terms of “essentialist beliefs about female caregiving [that] continue to be a dominant cultural ideology even among people who endorse gender egalitarianism.” This means that even people who, on an intellectual level, believe that child care should be shared, in practice delegate the majority of it to the female partner.

This is one of the main mechanisms that keeps the gendered pay gap in place. Currently, women employed full-time earn on average 77 cents for every dollar a man makes. The way this happens isn’t as simple anymore as paying a female worker less for the same position as her male colleague. For young women, the gap is smaller (7% less than men), which shows that since young women are more likely to be childless they have more flexibility in the labor market.

Women’s educational achievements and amounts of workplace experience have risen highly in the last four decades, traditionally signs that they will have higher-paid jobs. But despite this, women workers are two-thirds of the 20 million in low-wage jobs (less than $10.10 per hour – actually still a poverty wage) even though they are a little less than half of the total workforce. They are overrepresented in professions that relate to caregiving, playing to ideas of traditional gender roles, like child care workers, waitressing, home health care and cleaning. Besides these jobs, they are likely to be found in sectors like fast food and retail that pay at or very close to the minimum wage.4

This trend has increased since the 2008 recession, 35% of women’s net job gains since then have been in these low-wage occupations compared to 20% for men. One third of these women are mothers. For Black and Hispanic women, the gap widens more compared to white women. At $10.10 an hour, working full-time and with year-round employment, a worker with two children would just barely keep her head above the poverty line with an annual income of $20,200. If she was paid the federal minimum wage of $7.25 an hour, she would fall far beneath it at $14,500. How inadequate is $10.10 that even at full time it can barely push a woman’s wage above the government’s own official (read conservative) poverty line?

The numbers are even more dramatic for single mothers. Families with a working mom are less than 25% of the total number of families, but almost 40% of low-income families. More than half are working full time. While not all working single mothers live in poverty, the majority, 58 percent as of 2012, of female-headed working households are in low wage occupations. For African Americans it’s even higher, at 65 percent. Single mothers are an at-risk population for depression, although they often go undiagnosed and untreated because of underrating the importance of their symptoms or not being able to access health care.

Access to child care is a major barrier for these mothers, who are often forced to patch together informal arrangements with their personal support networks of friends and family. Actually, child care costs hit workers in higher-income households hard too, which goes a long way toward explaining why so much of it is still home-based in a way that disadvantages women. Enrolling a child in daycare can cost more than a month’s rent or food bill, seriously limiting the options available to working women. For some examples, full-time annual child care center enrollment can cost around $16,000 in Massachusetts for an infant and $12,300 in New York for a four year old. In 31 states, the cost is higher than it would be for a year of college in a four-year public university. In every state, it’s more than 25 percent of a single parent’s median income. For most people, staying home isn’t an option even if they wanted to have a “traditional” male breadwinner and female housewife relationship, since almost half of American families have two working parents.

At the same time, social support policies to provide child care assistance to low-income families are experiencing budget cuts. In 2013, the U.S. Congress cut $400 million from the Head Start program that gives young children from poor families access to preschool and $115 million from the Child Care and Development Block Grant that gives money to local authorities to spend on subsidies for day cares. This is part of an ongoing trend in cutting these programs, which has been partially countered but overall makes them unable to keep up their current levels of service, let alone expand. Without affordable child care made available, it falls to women by default to do it. If they have problems, if they can’t “do it all” and balance their work and home lives by themselves, they’re seen as personal failures instead of social problems.

These women basically subsidize their employers and their partners’ employers by providing their own child care. The same thing happens with maternal leave. The United States is the only advanced industrialized country in the world that doesn’t doesn’t guarantee paid parental leave after childbirth or adoption. In fact, not only is it the only high-income country that doesn’t do this, it’s the only country altogether besides Papua New Guinea. The U.S. passed the Family Medical Leave Act (FMLA) in 1993, which guarantees up to twelve weeks of unpaid leave, but there are exceptions.

The worker must have worked for at least one year at his or her place of employment, worked at least 1,250 hours during that year, and works in a business that employs at least 50 people if in the private sector. Taking unpaid time off is cost-prohibitive for many, especially in low wage jobs. Some employers do provide paid parental leave for their employees for either or both parents, with paid leave more likely in unionized workplaces and the public sector. California has a Paid Family Leave (PFL) program, an insurance fund that is paid for by contribution from employees’ paychecks and provides temporary partial compensation for people who take time off for having children, adopting or caring for a sick family member. New Jersey and Washington have similar programs. Another regressive tax on working people.

For women who don’t have a paid leave option, they either don’t take any time off at all besides what’s absolutely medically necessary or they use a combination of different legal and employer provided measures. Accumulated vacation time, personal days, sick days and paid time off may be used in some combination, plus applying for short-term disability in the states where STD benefits can be claimed for childbirth.

Women in the United States continue to struggle with an uneven playing field in the workplace, given most of the responsibility for child care and the home but not given adequate tools to deal with those responsibilities beyond what their own backgrounds and personal support systems can give. We need to take concrete steps toward leveling the playing field. As stated above, most countries already have guaranteed paid parental leave. The Netherlands, an advanced capitalist economy but not nearly as rich as the U.S., offers 16 weeks at full pay. Canada requires between 17 and 52 weeks of leave for new mothers depending on their employment time, with an additional partially paid (not the full wage) benefit that can be shared between both parents. All thanks to the pressure exerted by the working class movement.

Subsidized or public child care should also be brought up to at the level it’s at in the other high-income countries. Ideally, the U.S. would bring back the brief universal child care program it had between 1943 and 1946, where the federal government sponsored cheap child care for women to access so they could work as part of the war effort.

 

Notes

  1. Alexandra Kollontai, “The Labour of Women in the Evolution of the Economy.”
  2. http://weeklyworker.co.uk/worker/960/alexandra-kollontai-emancipation-through-the-russi/
  3. Cha Youngjoo, “Overwork and the Slow Convergence in the Gender Gap in Wages.”
  4. http://www.nwlc.org/resource/underpaid-overloaded-women-low-wage-jobs

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