To Help People in Poverty, We Must Ask the Right Questions

A child hides in the closet at school and refuses to come out. Once that might have been seen as an act of disobedience. Today most teachers know that such behavior could be a response to a traumatic event. A teacher would get the family, school social worker and other professionals involved to explore what was happening in the child's life and to offer the necessary support. We call this being "trauma-informed."

Those of us in the helping professions must also be basic-needs informed. In collaboration with my colleagues at the New Haven MOMS Partnership, I created the Basic Needs-Informed Curriculum to help social workers, clinicians and educators recognize when the lack of a material thing – often a simple one – is causing serious health, family, school or work problems.

For example: A teenage girl misses about a week of school each month. That sets her up for academic failure and, in some states, referral to juvenile court for truancy. Maybe her parents aren't supervising her. Maybe she is on drugs. Or maybe she stays home when she has her period, because she has no feminine hygiene products. We accept that this happens in the developing world. People in the United States struggle with necessities too. There is a wide gap between the money people obtain from public assistance or low-wage jobs and the money it takes to cover basic needs.

Being basic needs-informed sounds simple, but it's a departure from how most systems have traditionally operated. As a social worker serving formerly homeless families, I often noted problems with cleanliness. The house would be dirty. Clothes would smell ripe. And – most disturbing to me – babies would spend the day in dirty diapers. Was mom too depressed to keep her apartment and children clean? Did she not understand how unhealthy this was? These were the kind of questions that my training prepared me to ask.

I found that there were different questions that frequently got to the heart of the problem: Do you have a broom, laundry detergent, enough diapers? Often my clients knew what do to and wanted badly to do it. I didn't need to fix my client; I needed to get her stuff. This on-ground-experience is starting to be validated by research.

MOMS reaches out to low-income mothers to promote mental wellness. The Yale-affiliated project also does research that is demonstrating how access to basic needs affects a family's overall well being. An important study conducted by MOMS together with the National Diaper Bank Network found that about 30 percent of low-income mothers could not afford enough diapers to change their children frequently. Being without an adequate supply of diapers was a huge stressor – even bigger than food insecurity – and was associated with depression.

That is extremely concerning. A 2003 study found that the cost of depression to employers was $83 billion a year. Even that is dwarfed by the pain of individuals and families. Parental depression is linked to developmental, behavioral, academic and health problems in children.

I was trained to recognize the signs of depression and could refer any of my clients to treatment. But I was not trained to ask about the nuts and bolts, the small things whose absence could send a life off the rails. How many mothers' mental health could be improved by getting them access to these things? A month's worth of diapers costs about $75. That's beyond the reach of many low-wage parents – but cheaper than therapy by a long shot.

Certainly this is not a plea to cut mental health services, which many low-income people desperately need. I'm merely saying: Let's first find out if the problem is rooted in not having something like bus fare or dish detergent. That's the real advantage of being basic-needs informed – it can shine a light on ways to help people become healthier and more independent almost immediately.

If you are a clinician, social worker or educator working with people in poverty and would like to learn more, please contact