Child Development Account Research Articles

A Cluster-Randomized Controlled Trial of an Economic Strengthening Intervention to Enhance Antiretroviral Therapy Adherence among Adolescents Living with HIV.

We examined the impact of an economic empowerment intervention on ART adherence among ALHIV. We used data from 455 ALHIV, randomized into intervention, n = 111, and control n = 344. ALHIV were aged 12-16 and recruited from 39 clinics in Uganda between January 2013 and December 2015. The intervention comprised a long-term child development account (CDA), micro-enterprise workshops, and educational sessions. Adherence was measured using unannounced pill counts. We used mixed-effects logistic regression analysis to examine the effect of the intervention on ART adherence. The mean age was 12.6 years. Despite observing non-significant group main effects, we found significant group-by-time interaction effects χ2(5) = 45.41, p < 0.001. Pairwise comparisons showed that compared to the control group, participants who received the intervention had significantly higher adherence at visit four, OR = 1.52 (95% CI: 1.07-2.18), p = 0.020; visit five, OR = 1.59 (95% CI: 1.06-2.38), p = 0.026; and visit six, OR = 1.94 (95% CI: 1.24-3.04), p = 0.004. Efforts to support ALHIV to live longer and healthier lives should incorporate components addressing poverty. However, declining adherence raises concerns over ALHIV's long-term well-being. The trial was registered at ClinicalTrials.gov, registration number NCT01790373, with a primary outcome of adherence to HIV treatment.

Baby Bonds: Saving for America’s Future

Child Development Accounts are government-established and maintained savings accounts for children born to qualifying, generally low-income, families. Often seeded with a cash grant from the government, the savings account can be accessed when the child turns 18 for specific purposes such as financing education, buying a house, or opening a business. While Child Development Account policies have been implemented by some local and state governments, the American Opportunity Accounts Act (AOAA) proposes to establish a Child Development Account for all American children at birth. The sponsors of the AOAA believe that the legislation will reduce income inequality and reduce the racial wealth gap in the United States. An economic analysis of the AOAA predicts that the proposed legislation would incentivize middle-income families to have more children than they otherwise would while also reducing the private saving levels of middle-income families for future child-related expenses. Similar effects are not expected in low- and high-income families. Finally, the results of the analysis demonstrate that if policymakers wish to achieve the maximum possible reduction in the income and racial wealth gap, then AOAA benefits should be limited solely to low-income families.

자립준비청년 사회보장제도 이용의 영향요인 분석

Objectives: This study aims to examine the predictors on welfare receipt among youth in out-of-home care (youth preparing for independence) by using administrative data including the Social Welfare Facilities Information System and the Social Security Information System. Methods: The study analyzed 12,280 youth in out-of-home care, and the logistic regression models using Stata 15.0 was employed to examine the associations between sociodemographic characteristics, out-of-home care characteristics, and welfare receipt including self-reliance allowance, Child Development Account (Didim Seed Account), and the National Basic Livelihood Security benefits.&#x0D; Results: First, the study found that the younger youth, who stayed for a longer period at out-of-home care, youth in foster care, youth with higher educational level, and unemployed youth were less likely to receive self-reliance allowance when compared to older, youth who stayed for a shorter period at out-of-home care, youth in childcare facilities, youth with lower education, and employed youth. Second, female, the older, youth who stayed shorter period at out-of-home care, youth in foster care, and youth with higher education level were less likely to open the Child Development Account when compared to male, the younger, youth who stayed for a longer period at out-of-home care, youth in childcare facilities and group homes, and youth with lower educational level. Third, male, the older, youth who stayed for a shorter period at out-of-home care, youth in foster care, youth with higher educational level, and employed youth were less likely to receive the Livelihood Benefits including medical and housing assistance when compared to female, the younger, youth who stayed for a longer period at out-of-home care, youth in childcare facilities, youth with lower educational level, and unemployed youth.&#x0D; Conclusions: Based on the findings, the study suggests implications for promoting the use of welfare receipt among youth in out-of-home care.

A Structural Equation Model of the Impact of a Family-Based Economic Intervention on Antiretroviral Therapy Adherence Among Adolescents Living With HIV in Uganda

PurposeAntiretroviral therapy (ART) adherence among adolescents living with HIV (ALWHIV) is low, with poverty remaining a significant contributor. We examined the mediation pathways between an economic empowerment intervention and ART adherence among ALWHIV. MethodsThis cluster-randomized controlled trial (2012–2018) recruited 702 ALWHIV aged 10–16 in Uganda between January 2014 and December 2015. We randomized 39 clinics into the control (n = 344) or intervention group (n = 358). The intervention comprised a child development account, four microenterprise workshops, and 12 mentorship sessions. We used six self-reported items to measure adherence at 24 months, 36 months, and 48 months. We used structural equation modeling to assess the mediation effects through mental health and adherence self-efficacy, on adherence. We ran models corresponding to the 24, 36, and 48 months of follow-up. ResultsThe mean age of the participants was 12 years, and 56% were female. At 36 (model 2) and 48 months (model 3), the intervention had a significant indirect effect on ART adherence [B = 0.069, β = 0.039 (95% confidence interval [CI]: 0.005–0.074)], and [B = 0.068, β = 0.040 (95% CI: 0.010–0.116)], respectively. In both models, there was a specific mediation effect through mental health [B = 0.070, β = 0.040 (95% CI: 0.007–0.063)], and [B = 0.039, β = 0.040 (95% CI: 0.020–0.117)]. Overall, 49.1%, 90.7%, and 36.8% of the total effects were mediated in models, 1, 2, and 3, respectively. DiscussionEE interventions improve adherence, by improving mental health functioning. These findings warrant the need to incorporate components that address mental health challenges in programs targeting poverty to improve ART adherence in low-income settings.

Monitoring adherence to antiretroviral therapy among adolescents in Southern Uganda: comparing Wisepill to Self-report in predicting viral suppression in a cluster-randomized trial.

IntroductionOptimal antiretroviral therapy (ART) adherence is crucial for improved patient outcomes; however, ART adherence among adolescents living with HIV (ALHIV) is low. Also, the performance of various adherence measures among ALHIV is under contention. We monitored ART adherence and compared Self‐report (SR) and Wisepill electronic monitoring (EM) performance in measuring ART adherence and predicting HIV viral suppression among ALHIV.MethodsBetween January 2014 and December 2015, we recruited 702 ALHIV aged 10–16 years into our cluster‐randomized controlled trial (2012–2018) in 39 clinics in Uganda. The intervention included a long‐term savings child development account, four micro‐enterprise workshops and 12 mentorship sessions. Using the entire sample, we performed multilevel logistic regression to predict monthly ART adherence trends for the first year of follow‐up. Since it is possible that the intervention had different effects on SR and EM adherence, we used participants in the control arm only to compare adherence using SR and EM and to calculate their sensitivity and specificity in predicting viral suppression.ResultsThere was a significant decline in adherence for each month throughout the entire follow‐up period regardless of the group assigned. Good ART adherence was measured at 79.2% (75.2–82.6%) and 97.0% (95.4–98.1%) using EM and SR, respectively. Overall, 64.3% (60.6–67.9%) had suppressed viral loads. The specificities for EM and SR in predicting viral non‐suppression were 80.4% (73.6–85.7%) and 96.7% (93.3–98.4%), while the sensitivities were 22.9% (15.0–33.3%) and 1.8% (0.4–6.9%), respectively. The area under the curve was low for both EM and SR, at 53.6% (45.7–61.5%) and 56.2% (53.2–59.3%), respectively. There was high agreement (78%) between SR and EM in monitoring adherence.ConclusionsOur findings highlighted the need for strategies for sustained optimal adherence. SR and EM measure adherence with a considerable agreement; however, neither is an accurate predictor of virological outcome. There is still a need for an acceptable, feasible and affordable method that predicts viral suppression among ALHIV.

Interventions designed to improve financial capability: A systematic review.

There is growing recognition that people need stronger financial capability to avoid and recover from financial difficulties and poverty. Researchers are testing financial capability interventions with adults, children, immigrant populations and other groups, but little is known about the effectiveness of financial capability interventions on financial behaviour and financial outcomes. The purpose of this review is to inform practice and policy by examining and synthesizing evidence of the effects of interventions designed to improve financial capability. Financial capability interventions combine financial education and financial products and/or services. The research questions are: (a) What are the effects of interventions designed to improve financial capability on financial behaviour and financial outcomes? and (b) Does study(design), intervention (dosage, duration, type) or sample (age) characteristics relate to the magnitude of effect size? We conducted two identical rounds of electronic searches for two different time periods. In Round 1 searched for studies through May, 2017 and Round 2 searched from May, 2017 through May, 2020. For both rounds, we identified and retrieved both published and unpublished studies, including conference proceedings, through a comprehensive search that included multiple electronic databases, grey literature sources, organizational websites, government websites and reference lists of reviews and relevant studies. We also conducted forward citation searching using Google Scholar to search for studies citing the included studies. We also conducted a search on Google using key terms. We hand searched the table of contents of selected journals to identify potentially eligible reports not properly indexed. Finally, experts who were study or sub-study authors of prior studies were contacted in an attempt to obtain unpublished studies, studies in process and published studies missed in the database search. To be eligible for this review, the intervention must have included a financial education component and a financial product or service. Studies must have also been conducted in any of the 35-member countries of the OECD, and included a financial behaviour or financial outcome. To meet the criteria for delivering financial education, interventions must have delivered information about: (1) a variety of general financial concepts and behaviours, or advice about financial behaviours); (2) a specific financial topic; (3) a specific product; and/or (4) a specific service. To meet the criteria for access to a financial product or service, interventions must have facilitated access to one or more of the following: (1) a child development account; (2) a retirement account through an employer; (3) a 'second chance' checking account; (4) a matched savings account; (5) a financial service, such as financial counselling or coaching; (6) a bank account; (7) an investment vehicle; or (8) a home mortgage loan product. Electronic searches of bibliographic databases and searches of other sources identified a total of 35,484 hits. Titles and abstracts were screened for relevance and 35,071 were excluded as duplicates or deemed inappropriate. The full text of the remaining 416 potential studies was reviewed and screened for eligibility by two independent coders. We excluded 353 reports that were deemed ineligible and included 63 reports that met inclusion criteria. Of the 63, 15 reports were deemed duplicates or summary reports. Of the remaining 48 reports, 24 were unique studies (using unique samples) that were included in this review. Six of those 24 studies were large longitudinal studies that presented unique analyses (using different time points, subsamples, and/or outcomes). Thus, we extracted data from 48 reports, reporting data and analyses from 24 unique studies. At least two review authors who were not study authors independently assessed risk of bias in all included studies using the Cochrane Collaboration's risk of bias tool. The review summarizes evidence from 63 reports from 24 unique studies, which included 17 randomized controlled trials and 7 quasi-experimental designs. In addition, 17 duplicate or summary reports were also located. This review identified several different types of previously evaluated financial capability interventions. Unfortunately, few interventions that were evaluated by more than one study measured the same or similar outcomes, thus there were not a sufficient number of studies of any of the included intervention types that could be pooled to conduct a meta-analysis. Therefore, evidence is sparse about whether participants' financial behaviours and/or financial outcomes are improved. While the majority of the studies used random assignment (72%), many of the studies had some important methodological weakness. There is a lack of strong evidence about the effectiveness of financial capability intervention. Better evidence is needed about the effectiveness of financial capability interventions to guide practitioners.

Household Savings Decisions in Israel’s Child Savings Program: The Role of Demographic, Financial, and Intrinsic Factors

Israel’s Child Development Account (CDA) program, the Savings for Every Child Program (SECP), is universal and automatically enrolls all children under the age of 18, depositing 51 shekels (approximately USD 14) into their accounts every month. Parents can double this savings amount and can choose an investment vehicle for their children’s deposits. The total realized benefits from the SECP depend heavily on parents’ choices. This study examines how demographic, financial, and intrinsic personality characteristics predict household participation in this program. Using a unique data set combining administrative and survey data, we find that household religion/ethnicity, parental education, and financial circumstances were the most significant predictors of household engagement with the SECP. Important differences in program enrollment and participation are observed by household religion/ethnicity. Our study informs potential policy designs of CDA programs, especially in middle- and high-income countries, and have implications for enabling less-educated and religious/ethnic minority households to save for their children’s future.

Utilizing a family-based economic strengthening intervention to improve mental health wellbeing among female adolescent orphans in Uganda

BackgroundIt is estimated that almost 20% of the world’s adolescents have experienced or are experiencing a mental health problem. Several factors have been associated with the onset of adolescent mental health disorders, including poverty, child abuse and violence, particularly among adolescent girls. This paper examines the effect of participating in a family-based economic strengthening intervention on the mental health well-being of female adolescent orphans impacted by HIV/AIDS in rural Uganda.MethodsData utilized in this study was from the Bridges to the Future Study (2011–2016), an economic empowerment intervention aimed at improving health outcomes of orphaned children. Adolescents were randomly assigned to either the control condition receiving bolstered standard of care services for orphaned adolescents; or one of two treatment conditions receiving bolstered standard of care as well as an economic empowerment intervention comprising of a child development account, a mentorship program and workshops on financial management and microenterprise development. Data was collected at baseline, 12- and 24-months post intervention initiation. Multilinear regression analyses were conducted to examine the impact of an economic empowerment intervention on mental health functioning of female participants over time. Mental health functioning was measured by: (1) the Child Depression Inventory; (2) Beck Hopelessness Scale; and (3) Tennessee Self Concept Scale.ResultsAnalysis results show an improvement in mental health functioning over time among female participants receiving the intervention compared to their control counterparts. Specifically, compared to participants in the control condition, participants receiving the intervention reported a reduction in depressive symptoms from baseline to 12-months follow-up (b = − 1.262, 95% CI − 2.476, − 0.047), and an additional 0.645-point reduction between baseline and 24-months follow-up (b = − 1.907, 95% CI − 3.192, − 0.622). Participants receiving the intervention reported significant improvement in their reported self-concept from baseline to 24 months follow-up (b = 3.503 (95% CI 1.469, 5.538) compared to participants in the control condition.ConclusionsEmpowerment of young girls, either in the form of peer mentorship and/or economic strengthening seems to significantly improve the overall mental health functioning of adolescent girls impacted by HIV and AIDS in low-income settings.

Program Knowledge and Racial Disparities in Savings Outcomes in a Child Development Account Experiment

This study investigated whether participants’ program knowledge was associated with savings outcomes in Child Development Accounts and whether differences in program knowledge explained racial and ethnic disparities in savings outcomes. We used data collected from White, Black, American Indian, and Hispanic treatment participants in the SEED for Oklahoma Kids (SEED OK) experiment (N = 1126). Analysis results indicated that knowledge of SEED OK program features was low, especially among members of minority groups. Logit and Tobit regressions showed that program knowledge was positively related to the likelihood of holding a SEED OK account and to individual savings amounts. Gaps in program knowledge were associated with racial disparities in savings outcomes. If Whites and minorities had the same levels of program knowledge, gaps in savings outcomes would have significantly narrowed. The findings call for the development of policy designs and communication tools to enhance knowledge of program features among households with Child Development Accounts, especially racial- and ethnic-minority households.

Unmarried Mothers and Children’s Social-Emotional Development: The Role of Child Development Accounts

Research has established a negative association between single motherhood and child social-emotional development. This study examines whether Child Development Accounts, an economic intervention that encourages families to accumulate assets for children’s long-term development, buffer the association between single motherhood and child well-being and reduce social-emotional development disparities between children of unmarried and married mothers. The study analyzes data from a policy experiment of Child Development Accounts in Oklahoma, USA, which randomly selected a group of Oklahoma infants born in 2007 and randomly assigned their mothers to the treatment or control group. The intervention provides to the treatment group a Child Development Account built on the existing Oklahoma 529 College Savings Plan with additional financial incentives and information. The analytic sample includes 1,072 children in the treatment group and 1,049 in the control group. Children’s social-emotional development is measured by mothers’ reports of a shortened version of the Ages and Stages Questionnaire in the 2011 follow-up survey when these children were about age 4. Findings suggest that Child Development Accounts have significantly positive effects on social-emotional development for children living with unmarried mothers and eliminate the disparity in social-emotional development between the children of single mothers and those of married mothers. The study considers the implications of using such asset-building initiatives to improve child development.

Child Development Accounts and Parental Educational Expectations for Young Children: Early Evidence from a Statewide Social Experiment

AbstractParental expectations for their children’s education can have positive effects on child development, and thus they are appealing targets for interventions. We posit that a universal and progressive Child Development Account (CDA) started at the child’s birth may help to develop and maintain parental educational expectations. As a first step in assessing this proposition, we analyze data from SEED for Oklahoma Kids (SEED OK), an experiment designed to estimate the effect of CDAs on parental educational expectations for very young children. We assess the level and durability of expectations from birth to age 4 and find that SEED OK positively affects parents’ expectations for their children’s education at age 4 (N = 2,167) and that the proportion of mothers whose expectations remain constant or increase between birth and 4 years old is higher among those in the treatment group than among those in the control group.

Child development accounts (CDAs): An asset-building strategy to empower girls in Uganda.

This study explores an innovative intervention for orphaned children in Uganda. It combines standard health care with an economic empowerment component. We refer to this combination as a family asset-based intervention, which provides each child with a child development account (CDA), a matched savings account for secondary schooling; financial education; and a mentor. This article examines the educational outcomes of the girls in this study. The results from the first two waves of the study indicate that CDAs have the potential to begin to help negate the effects of past gender inequalities and to help provide a path for young girls to move forward.

Savings From Ages 16 to 35: A Test to Inform Child Development Account Policy

This study examines savings from childhood to young adulthood with a sample of 14,223 individuals from the 1996 Survey of Income and Program Participation (SIPP). We employed a cohort sequential accelerated latent growth model that combined a series of cohorts to represent a common developmental trajectory spanning 19 years—ages 16–35—and accounted for relevant covariates. Descriptively, the proportions of savings account ownership increased steadily between ages 16 and 30 and then leveled off. In other words, a critical time for intervention may occur between ages 16 and 30 when the proportion of account ownership is increasing. Proportions of savings accumulation also rose steadily, with a mean low of $636 between ages 16 and 20 to a mean high of $1,160 between ages 31 and 35. Gender, race, employment status, and household income and net worth were associated with initial variability in savings at ages 16–20 and rate of change in savings over time through age 35. Results can inform policies and programs that open savings accounts for children as a way of helping them remain financially secure across their life course.

The role of identity-based motivation and solution-focus brief therapy in unifying accounts and financial education in school-related CDA programs

Abstract This article focuses on unifying, seemingly at times, disparate aspects of school-related Child Development Account (CDA) programs in order to maximize their effects. Account ownership and financial education are the two key components of school-related CDA programs. Despite this most of the focus by asset theorists and researchers has been on the account ownership side of CDAs. To unify these two components we use identity-based motivation (IBM) theory. Further, we suggest that early experience with money failures and lack of positive role models results in many lower income and minority children entering CDA programs with low financial efficacy. Because of low financial efficacy, we suggest that in order for financial education programs to be successful among lower income and minority children they need to be designed to address this reality. We posit that a way to address the reality of lower income and minority students is to adopt solution-focus brief therapy (SFBT) techniques. These techniques can be used to teach financial education instructors how to build positive financial efficacy beliefs among lower income and minority children.

Early Program Enrollment in a Statewide Child Development Account Program

College Savings Plans (529 plans) and Child Development Accounts (CDAs) are two policy tools designed to encourage families to save for college. In Maine, a statewide CDA program has been established using the state's 529 plan platform and offering a $500 financial incentive for postsecondary education to every newborn. This program is designed to increase access to higher education by encouraging college savings at the beginning of a child's life. Survey data from eligible parents (N = 437) suggest that the $500 incentive was attractive and financially sophisticated parents were more likely to enroll their child. We conclude that financial incentives can increase enrollment in asset-building programs but are not the ideal strategy to achieve universal enrollment.

Financial Education and Financial Access: Lessons Learned from Child Development Account Research

Financial Education and Financial Access: Lessons Learned from Child Development Account Research

Financial Knowledge and Child Development Account Policy: A Test of Financial Capability

This study examines how study participants' financial knowledge and participation in a Child Development Account intervention affects 529 College Savings Plan account holding among caregivers of infants. The study uses data from the SEED for Oklahoma Kids (N = 2,651), a statewide randomized experiment using a probability sample of infants selected from birth records. Results of logit regression show that participants' financial knowledge is positively related to account holding in the treatment group but not in the control group. The interactive effects between financial knowledge and treatment status are statistically significant. This finding implies that the effect of financial knowledge on financial decisions related to college savings is moderated by institutional features, such as incentives, information and access. Results of this study support the propositions of financial capability and suggest that expanding financial capability requires both improved individual financial knowledge and supportive policy.

A preliminary study on parents saving in the Child Development Account in Singapore

Abstract While Singapore is one of the countries having initiated the Child Development Account (CDA), there is little evidence examining how Singaporeans have saved in the program. This study tries to fill this gap by empirically examining how low-income households have participated and saved in the CDA. The study found that parents with awareness of the CDA scheme and those having savings in the CDA are likely to have higher views on importance of child's education and to posit more positive attitudes toward saving. Correlation analyses found that facilitation is strongly correlated with saving outcomes. Parents who prefer automatic inclusion of the CDA are likely to save more in these accounts. In addition, parents who positively view automatic deduction from salaries tend to save more in the CDA. Parents who are familiar with the regulations of the CDA such as the ‘no withdrawal before child turns age 7’ restriction and the rule on ‘automatic transfer of unused monies into the Post-Secondary Education Account (PSEA)’ are likely to save more. While the sample size is small (N = 65), findings from this study can provide a glimpse of saving performance in the CDA in Singapore as well as possible implications for policy and practice.

Early savings for children's higher education: A comparison between savers and non-savers in a Child Development Account program

This study examined economic pressure, parenting stress, and personal mastery factors among N = 235 lower income parents who had the opportunity to save for their children's future higher education in a children's development account program. Bivariate analyses and structural equation modeling (SEM) were used to test the differences between early savers and non-savers. There were some sociodemographic differences between the groups; however, the overall SEM was invariant between the groups. Data suggest that specific case management services may be critical to help lower-income parents save for their children. Further research needs to identify institutional aspects and household characteristics that explain saving among this poorer households.

Building assets from birth: a global comparison of Child Development Account policies

Asset building is a growing theme in public policy, and building assets from birth in the form of Child Development Accounts is now occurring in several countries. This article provides an overview of the Child Development Account policies in Singapore, Canada, the UK and Korea, and the proposed policy in the USA. The key elements of inclusiveness, progressivity, coherence and integration, and development are explicated and discussed.