Assessing Refugee Poverty Using Capabilities Versus Commodities: The Case of Afghans in Iran

This study is among the first to calculate poverty among one of the world’s largest refugee populations, Afghans in Iran. More importantly, it is one of the first to use capability and monetary approaches to provide a comprehensive perspective on Afghan refugees’ poverty. We estimated poverty using data collected from a sample of 2,034 refugee households in 2011 in Iran. We utilized basic needs poverty lines and the World Bank’s absolute international poverty line for our monetary poverty analyses and the global Multidimensional Poverty Index (MPI) for our capability analyses of poverty. Findings show that nearly half of the Afghan households were income-poor, approximately two percent of the households had less than USD 1.25 per person per day, and about 28% of the surveyed households were multidimensionally deprived. Results suggest that 60% of the income-poor households were not deprived from minimal education, health, and standards of living based on the MPI criteria, and about 32% of the multidimensionally deprived households were not income-poor. These findings call for more attention to poverty measurement methods, specifically for social workers and policy makers in the field, to gain a more realistic understanding about refugees’ wellbeing

Mentoring Students with Intellectual and Developmental Disabilities: Evaluation of Role-Specific Workshops for Mentors and Mentees

Transitioning to post-secondary education is often challenging for students with intellectual and developmental disabilities ( IDD ) . To address this, Florida International University, specifically FIU Embrace, piloted the Embrace Mentoring Program ( EMP ) , which provided unique role-specific workshops to both faculty/staff mentors, and student mentees with IDD. A mixed-method design was used to analyze knowledge acquisition and participant perceptions of the workshops. Quantitative findings indicated knowledge improvement in a key area for mentors, while qualitative data demonstrated a positive response to workshop content, and highlighted areas of improvement for future workshops. Ultimately, the results from the pilot EMP demonstrated promise in supporting students with IDD towards academic and career-related goals, by providing mentorship training to both mentors and mentees

They Survived, We Can Help Them Thrive: Older Adult Refugees in the United States

Letter to the editor originally addressed to the 2016 President-elect concerning older adult refugees in the United States

A Multidimensional Framework for Understanding Refugee Poverty in the United States

Background: The abrupt and unplanned nature of forced displacement usually leaves refugees with limited financial and social assets (Betts et al., 2017; Naseh et al., 2018). Moreover, forced displacement often interrupts refugees’ access to education and opportunities to invest in their human capital (Dryden-Peterson, 2011). These challenges together with other factors such as lack of familiarity with a new language, stigma and discrimination, and unfamiliarity with the job market can result in poverty among newly resettled refugees (Ekren, 2018; Lukasiewicz, 2017). This study aimed to build a multidimensional poverty framework for adult refugees with a specific focus on their first five years in the U.S. Conceptual framework: The conceptual framework was a combination of the monetary and capability approaches to poverty, Ager and Strang’s (2008) refugee integration framework, social exclusion theory, and Kuhlman’s (1991) comprehensive theoretical model for economic integration of refugees. Methods: The methodology used in this study consists of three elements: a systematic review of literature on risk factors for poverty among adult refugees, an inductive analysis of semi-structured interviews with key informants (n=10), and a secondary analysis of the 2016 Annual Survey of Refugees national dataset (n=1,500). Based on the results of the systematic review, factors associated with poverty among refugees were explored further using qualitative and quantitative analyses. Income poverty was calculated by comparing household income with national poverty lines. Multidimensional poverty was calculated using an adjusted version of the global Multidimensional Poverty Index (Alkire & Santos, 2010). Results: The systematic search found 779 unique studies, out of which only 31 explored poverty among refugees within their first five years in the U.S. Sex, ethnicity, access to transportation, discrimination, resettlement policies, English language proficiency, and social connections were the extracted factors that were cited in at least two studies. Thematic analysis of the qualitative data and Pearson’s chi-square tests between these factors and poverty among refugees provided further evidence of association. The identified risk factors for refugee income poverty and multidimensional poverty based on the triangulation of three data sources were grouped into four categories based on Kuhlman’s (1991) comprehensive theoretical model to form a multidimensional poverty framework. This proposed framework of this study suggests that refugee poverty at a household level (income poverty and deprivation in education, health, and housing) is interrelated to refugee household demographic characteristics (sex and ethnicity of the head of the household), resettlement policies, host-related characteristics (discrimination and access to transportation), and non-economic aspects of adaptation (English language proficiency and social networks). Conclusion: The findings contribute to the limited literature on poverty among refugees and have important implications for the social work profession in the context of this conference. The social work profession emerged as a response to poverty and addressing this problem has remained a core component of the profession (Krumer-Nevo et al., 2009). In this context, knowledge of factors associated with poverty among refugees is essential and relevant for social workers as front-line service providers. Social workers are well-positioned to advocate for economic justice for refugees as new Americans

Dementia-Related Neuropsychological Testing Considerations in Non-Hispanic White and Latino/Hispanic Populations

Hispanic individuals are at greater risk for health disparities, less than optimal health care, and are diagnosed at later stages of cognitive impairment than white non-Hispanics. Acculturation and different attitudes toward test-taking may result in decrements in performance, especially on unfamiliar measures that emphasize speed and accuracy. Non-Hispanic individuals often outperform Hispanic individuals on cognitive and neuropsychological measures in community and clinical populations. Current neuropsychological testing may not provide accurate data related to monolingual and bilingual individuals of Hispanic descent. Testing instruments were identified by searching academic databases using combinations of relevant search terms. Neuropsychological instruments were included if they were designed to detect cognitive impairment, had an administration time of less than 45 minutes, and were available in English. Validity studies were required to employ gold standard comparison diagnostic criteria. Twenty-nine instruments were evaluated in dementia staging, global cognition, memory, memory and visual abilities, working memory and attention, verbal learning and memory, recall, language, premorbid intelligence, literacy/cognitive reserve, visuospatial, attention, problem-solving, problem solving and perception, functional assessment, and mood/daily functioning domains. Spanish-language neuropsychological instruments need to be made widely available and existing instruments to be normed in Spanish to best serve and assess diverse populations. Psychometric data were reported for neuropsychological instruments, which may be administered to Hispanic older adults presenting for evaluation related to dementia-spectrum disorders. This is one of the few reviews to provide an overview of the sensitivity and specificity of available Spanish translated neuropsychological instruments

Assessing Refugees\u27 Multidimensional Poverty in the United States

Background: This study is among the first to calculate refugee poverty using the capability approach in the United States. The concept is novel as it avoids limitations of the monetary approach to poverty and provides a more comprehensive perspective on multiple deprivations that refugees might experience within their first five years of arrival to the United States. As the majority of refugees flee war or conflict-affected areas, they frequently escape with limited assets (Jacobsen, 2005; Potocky & Naseh, 2019). Often they spend their last resources on paying the smugglers to reach safety (Jacobsen, 2005) and arrive to host countries with limited to no belongings. Lack of assets, limited social support, physical or mental harms caused by forced displacement, lack of familiarity with the language, and under-evaluation of skills in host countries can result in multiple deprivations in refugees’ lives after resettlement (Ekren, 2018; Lewig et al., 2010; Potocky & Naseh, 2019; Zetter & Ruaudel, 2018). Conceptual framework: The most commonly used method for calculating poverty and separating poor, those in need of assistance, from non-poor, those usually not qualifying to receive help, is the monetary approach to poverty. In the monetary approach to poverty, households or individuals are labeled as poor if their income or expenditures are lower than pre-defined poverty lines (Haughton & Khandker, 2009). Although the monetary approach to poverty is a popular method, it has major limitations associated with using money as a proxy to quantify deprivations. The capability approach to poverty was introduced by Sen as a response to the limitations of the monetary approach to poverty (Sen, 1988, 1999). The capability approach argues that wellbeing is about opportunities that individuals or groups have to live the lives that they have reason to value (Robeyns, 2005). Among the more popular indices based on the capability approach is the global Multidimensional Poverty Index (MPI). An adjusted version of the MPI (aMPI) was used in this study. Methods: The 2016 Annual Survey of Refugees (ASR) dataset was utilized to explore multidimensional poverty among a representative sample of refugees in the United States. Provided U.S. census microdata by the Integrated Public Use Microdata Series (IPUMS) USA (Ruggles et al., 2019) was also used to compare the calculated multidimensional poverty rates among refugees with the general population. The aMPI was calculated based on the sum of the equally weighted poverty scores (1/3 or 0.33) in the three dimensions of education (indicator: school attainment), health (indicators: a. chronic diseases and b. disabilities), and standards of living (indicators: a. receiving food stamps, b. Refugee Cash Assistance [RCA], c. Supplemental Security Income [SSI], d. General Assistance [GA], e. Temporary Assistance to Needy Families [TANF], and f. living in public housing project). A household was categorized as poor if the aMPI score was 33.3% or greater. To better understand the calculated multidimensional poverty rates for refugees, these numbers were compared with poverty rates among the general population in the United States using the IPUMS USA online tool and the 2016 ACS dataset (Ruggles et al., 2019). Results: Multidimensional poverty among the surveyed households was around 63% (n=952). Poverty in the education dimension was 61% (n=921). In the health dimension, around 19% of the households (n= 284) had at least one member with a chronic health condition and around 10% (n= 156) had a member who was unable to work due to poor health conditions or a disability. In terms of deprivations in standards of living, around 55% (n=827) of refugee households had at least one member who received Food Stamp, around 18% (n= 275) had a member who received SSI, and less than five percent had a member who received RCA, GA, or TANF. Moreover, around 18% (n= 263) of the surveyed refugee households were living in a public housing project. Poverty rates among refugees were comparatively higher than the general population. Education poverty among the general population was three times lower compared to refugees. In the health dimension, poverty rates among the general population were similar to the calculated rates among refugees, but compared to refugees the general population was twice less likely to be enrolled in the government assistance programs Conclusion: Overall poverty rates among refugees were high and higher than the general population. Findings call for more attention to poverty measurement methods and encourage service providers, specifically social workers, to consider using multidimensional indices to gain a more realistic understanding of refugees\u27 poverty and wellbeing

Factors Associated with Poverty Among Refugees in the United States

Background and Purpose: Approximately three million refugees have arrived in the United States in the past four decades. Literature suggests, after arrival in the country and in the short-term period thereafter, it is likely for refugees as New Americans to experience poverty and deprivation in different aspects of life. In this context, knowledge of factors associated with poverty among refugees is important and relevant for social workers as front-line service providers for refugees and economically disadvantaged individuals. Using social exclusion theory as a framework, this study hypothesized that the factors associated with integration in the refugee integration conceptual framework (Ager & Strang, 2008) would be associated with poverty among refugees. To test this hypothesis, bivariate and multivariate correlational analyses were conducted between poverty and English language proficiency, length of residency, and application for permanent residency among refugees. To provide a more comprehensive picture of poverty and in line with the “markers and means” indicators in Ager and Strang (2008) framework, refugee poverty was quantified using households’ income (monetary approach to poverty) and household level deprivation in three domains: education, health, and housing (capability approach to poverty). Methods: The 2016 Annual Survey of Refugees (ASR) dataset was used in this study. The 2016 ASR was collected through structured phone interviews with 1,500 principal principle applicants for refugee status who arrived in the United States between the 2011 and 2015 fiscal years. Using Stata software program (version 15), Pearson’s chi-square test was conducted to measure bivariate correlations, Cramer’s V test was used to measure the strength of the bivariate correlations, and logistic regression was used for multivariate analysis. Results: Results showed statistically significant, negative, and weak correlations between income poverty and English language proficiency (χ2[1]= 7.40, p= 0.000, Cramer’s V= .10) as well as income poverty and length of residency in the United States (χ2[2]= 8.10, p= 0.02, Cramer’s V= .07). The correlation between multidimensional poverty and English language proficiency was statistically significant, negative, and strong (χ2[1]= 178.13, p= 0.000, Cramer’s V= .35). Moreover, the correlation between multidimensional poverty and application for permanent residency was statistically significant, negative, and weak (χ2[1]= 16.59, p= 0.000, Cramer’s V= .07). Multivariate models showed that lack of English language proficiency is the best predictor for income (Odds Ratio=1.5, p= 0.002) and multidimensional poverty (Odds Ratio= 4.4, p= 0.000). Conclusions and Implications: These findings call for attention to English language training among refugees. Although English language classes are among the first services suggested for refugees upon arrival to the country, many cannot benefit from them due to lack of access to transportation, childcare, and long hours of work. Online or in-home English tutoring programs may be more practical for some refugees and investment is needed to enhance the scale of these programs and provide the required tools such as computers, smart phones, and Internet access for refugees to benefit from them. Additionally, access to English language classes could also be provided and promoted while refugees are in host countries waiting to be resettled in the United States

Mild cognitive impairment: associations with sleep disturbance, apolipoprotein e4, and sleep medications

Objective: Mild cognitive impairment (MCI) is associated with increased memory problems although the ability to complete daily life activities remains relatively intact. This study examined: (1) if sleep disturbance increased the hazard of MCI; (2) if APOE e4 carriers with sleep disturbance experience an increased risk of MCI; and, (3) if prescription sleep medications provide a protective effect against MCI. We hypothesized that sleep disturbance increases the hazard of MCI, this relationship is stronger among APOE e4 carriers reporting a sleep disturbance. Furthermore, we hypothesized that sleep medications decrease the hazard of MCI. Methods: To determine whether sleep medication mediates the risk of developing MCI for individuals with sleep disturbance and/or APOE , we analyzed the National Alzheimer\u27s Coordinating Center Uniform Data Set. We selected participants with normal cognition at baseline (n = 6798), and conduced survival analyses. Results: Our main findings indicated that the hazard of MCI was significantly associated with sleep disturbance. The hazard remained among those who did not use sleep medication. Trazodone and zolpidem users did not have a significant hazard of MCI, but the significant hazard remained for those who did not use these medications. APOE e4 carriers had a significantly higher hazard of MCI. Among e4 carriers who used trazodone or zolpidem, there was not a statistically significant risk of MCI. Conclusion: This study demonstrated the potential utilization of trazodone and zolpidem in the treatment of sleep disturbance while potentially mitigating the risk of MCI. While trazodone and zolpidem have been shown to positively impact sleep disturbance in individuals with normal cognition, further research should explore these findings given that these medications are potentially inappropriate for older adults. e

Factors influencing attrition in 35 Alzheimer’s Disease Centers across the USA: a longitudinal examination of the National Alzheimer’s Coordinating Center’s Uniform Data Set

Objective: A lack of understanding of the causes of attrition in longitudinal studies of older adults may lead to higher attrition rates and bias longitudinal study results. In longitudinal epidemiological studies of Alzheimer’s disease and related dementias, high rates of attrition may cause a systematic underestimation of dementia prevalence and skew the characterization of the disease. This can compromise the generalizability of the study results and any inferences based on the surviving sample may grossly misrepresent the importance of the risk factors for dementia. The National Institute on Aging outlined a National Strategy for Recruitment and Participation in Alzheimer’s Disease Clinical Research to address this problem, providing evidence of the magnitude of this problem. Method: To explore predictors of attrition, this study examined the National Alzheimer’s Coordinating Center ( NACC ) Uniform Data Set, a repository of observations of older adults spanning 11 years, using survival analysis. Four samples were examined: the full sample ( n = 30,433 ) , the alive subsample excluding those who died ( n = 24,231 ) , the MRI sample [participants with complete MRI data ( n = 1104 ) ] , and the alive MRI subsample [participants with MRI data excluding those who died (n = 947 ) ] . Results: Worsening cognitive impairment, neuropsychiatric symptoms, and difficulty with functional activities predicted attrition, as did lower hippocampal volume in the MRI subsample. Questionable co-participant reliability and an informant other than a spouse also increased risk of attrition. Discussion: Special considerations exist in recruiting and retaining older adults in longitudinal studies, and results of baseline psychological, functional, and cognitive functioning should be used to identify targeted retention strategies

Dementia-related neuropsychological testing considerations in non-Hispanic White and Latino/Hispanic populations.

© 2019 American Psychological Association. Hispanic individuals are at greater risk for health disparities, less than optimal health care, and are diagnosed at later stages of cognitive impairment than white non-Hispanics. Acculturation and different attitudes toward test-taking may result in decrements in performance, especially on unfamiliar measures that emphasize speed and accuracy. Non-Hispanic individuals often outperform Hispanic individuals on cognitive and neuropsychological measures in community and clinical populations. Current neuropsychological testing may not provide accurate data related to monolingual and bilingual individuals of Hispanic descent. Testing instruments were identified by searching academic databases using combinations of relevant search terms. Neuropsychological instruments were included if they were designed to detect cognitive impairment, had an administration time of less than 45 minutes, and were available in English. Validity studies were required to employ gold standard comparison diagnostic criteria. Twenty-nine instruments were evaluated in dementia staging, global cognition, memory, memory and visual abilities, working memory and attention, verbal learning and memory, recall, language, premorbid intelligence, literacy/cognitive reserve, visuospatial, attention, problem-solving, problem solving and perception, functional assessment, and mood/daily functioning domains. Spanish-language neuropsychological instruments need to be made widely available and existing instruments to be normed in Spanish to best serve and assess diverse populations. Psychometric data were reported for neuropsychological instruments, which may be administered to Hispanic older adults presenting for evaluation related to dementia-spectrum disorders. This is one of the few reviews to provide an overview of the sensitivity and specificity of available Spanish translated neuropsychological instruments