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The Child Support Improvement Project: Paternity
Establishment, Chapter 8
CHAPTER VIII
SUMMARY, IMPLICATIONS AND CONCLUSIONS
A. Summary
The Colorado demonstration project shows that in-hospital
paternity interventions can produce dramatic increases in the
voluntary paternity acknowledgement rate. A comparison of pre-
and post-project voluntary acknowledgement rates in the four
Denver area hospitals in which the experiment was conducted
revealed that rates doubled or came close to doubling in each
hospital setting. At Denver General Hospital, the voluntary
acknowledgement rate rose from 13 to 27 percent. At Mercy
Hospital, it rose from 24 to 40 percent. At St. Joseph Hospital
the rate rose from 20 to 52 percent. Finally, at University
Hospital, the voluntary acknowledgement rate rose from 22 to 36
percent.
Despite the dramatic increase in acknowledgements following
the initiation of in-hospital overtures to unmarried parents
using simplified acknowledgement procedures, many parents refuse
to sign. Depending upon the hospital, 48 to 73 percent of
unmarried parents failed to voluntarily acknowledge paternity
during the demonstration project. To better understand the
incentives and disincentives to voluntary paternity
acknowledgement, we compared the demographic characteristics of
1,144 acknowledgers versus 2,758 disavowers, reviewed various
state databases for evidence of their financial self-sufficiency
or dependence at nine and fifteen months following delivery and
interviewed a sample of 100 unmarried mothers who delivered at
Denver General Hospital.
The research revealed that while the in-hospital effort
translated into improved voluntary paternity acknowledgement
patterns with virtually all demographic sub-groups, the process
remained more appealing to certain types of unmarried parents.
Voluntary acknowledgement rates were significantly higher for
unmarried mothers who were White, educated at least at the high
school level, employed during pregnancy and had no or only one
prior birth. Unmarried mothers with these characteristics were
most receptive to voluntary paternity acknowledgement both before
the start of the demonstration project and after its inception.
One consequence of the in-hospital paternity outreach effort
was a dramatic increase in voluntary acknowledgements among
African-American women. The increase was most pronounced among
those with more than a high school education. Nevertheless,
although more educated women of color achieved acknowledgement
rates that were more comparable to those of their White
counterparts at similar education levels, race and Hispanic
origin continued to influence the voluntary acknowledgement
process with White women having the highest level of
acknowledgements. It appears that while in-hospital outreach
efforts can make paternity inroads with populations historically
ignored, significant racial and ethnic differences persist.
Interviews with unmarried mothers indicate that parental
relationship factors feature heavily in the decision to put the
father's name on the birth certificate. Mothers who signed their
portion of the voluntary paternity acknowledgement form were
significantly more likely to report cohabitation, regular contact
and the likelihood of marriage or a long-term relationship. The
chief reasons they cited for failing to sign were bad
relationships with the baby's father followed by concerns about
the father gaining custody or visitation rights.
Paternal participation factors were also correlated with the
voluntary acknowledgement rate. Voluntary acknowledgements were
significantly more apt to occur when the father had attended the
birth and fathers in turn were significantly more apt to attend
if the birth was the mother's first or second child rather than
her third of fourth. The number of prior births, however, also
had effects that were independent of father's attendance at the
birth. Among fathers present at the delivery, voluntary paternity
acknowledgement rates declined significantly with each prior
child. We can only speculate on the reasons for these patterns.
It is possible that in multiple birth situations, unmarried
fathers avoid paternity acknowledgement because they feel a
diffused sense of responsibility, are overwhelmed by the
magnitude of the potential child support burden they might face,
and/or have prior experiences suggesting that paternity
acknowledgement has little practical significance.
Financial characteristics of unmarried parents come into
play in predicting who will voluntarily acknowledge paternity.
Paternity acknowledgement was significantly more attractive to
parents who were financially independent at the time of the
child's birth. Thus, voluntary acknowledgement rates were
significantly higher for parents who had never been involved with
AFDC or Medicaid as compared with parents receiving these
benefits at the time of the birth. In interviews, unmarried
mothers who signed the voluntary paternity acknowledgement were
more likely to report that the father of the child provided
financial support during their pregnancy and that they expected
him to continue to help out financially. The fathers of children
whose partners signed were also more likely to be employed on a
full-time basis.
Voluntary paternity acknowledgement is also correlated with
the financial status of unmarried parents nine and fifteen months
following delivery of their babies. At both time points,
acknowledgers were significantly more likely to be financially
independent and uninvolved with AFDC. Nine months after delivery,
only 33 percent of those who acknowledged paternity were on AFDC
compared to 57 percent of those who disavowed. At fifteen months,
the AFDC receipt rate for acknowledgers versus disavowers was 25
percent and 41 percent, respectively. Acknowledgers and
disavowers were equally apt to be recipients of Medicaid at nine
and fifteen months following delivery, suggesting that this
benefit is transitional and an unreliable indicator of longer
term financial dependence.
In addition to being less involved with the welfare system,
parents who acknowledged voluntarily were less involved with the
child support system. Fifteen months after delivery about 23
percent of acknowledging parents had an open child support case
compared to 39 percent of those who did not voluntarily
acknowledge.
Voluntary paternity acknowledgement clearly appeals to
parents who are more economically self-sufficient. Moreover,
among those in the state child support system, acknowledgers do
not appear to reap any particular child support benefits.
One possible reason is that child support workers frequently
fail to learn about in-hospital acknowledgements using
traditional intake techniques and consequently classify these
cases as needing paternity to be established. This can lead to
delay in case processing and understate the state's paternity
establishment percentage. One solution to this problem is to
develop an automated interface between the child support and
vital records agencies so that workers do not have to rely on
information on paternity status supplied by the client and/or go
through the time-consuming task of ordering a hard copy of the
birth certificate for each applicant or recipient case.
More to the point, while unmarried births with voluntary
acknowledgements were somewhat more likely to have a child
support order in place after fifteen months (26 versus 20
percent), only 5 and 6 percent of open child support cases for
acknowledgers and disavowers, respectively, were receiving
payment. While paternity establishment is a necessary first step,
the regular receipt of child support clearly depends more upon
the identification and attachment of a wage or asset than on
hospital room signatures.
Many unmarried parents appear to have little investment in
the formal child support system. Fear of child support was the
most frequently cited reason given by mothers to explain why
fathers fail to sign the voluntary paternity affidavit.
Moreover, whether or not they were interested in voluntary
paternity acknowledgement, few unmarried mothers expressed
interest in obtaining a formal child support order. Interest in
child support was expressed by only 25 and 19 percent of
interviewed mothers who signed and failed to sign, respectively.
The evidence is mixed on whether mothers avoid paternity
acknowledgement to protect their benefit status. Although few say
this is a personal reason for not signing the affidavit, nearly
half agreed with the general statement that "women don't want
fathers on the birth certificate as the legal father of the child
because they can get more benefits on their own."
B. Implications
Although in-hospital paternity acknowledgment programs may
reduce the burden to the state of a portion of the costs
associated with adversarial establishment procedures, these
programs have not had all the financial benefits that were hoped
for at least in the short-term. In addition to revealing some of
the financial limitations to voluntary acknowledgements, the
Colorado demonstration provides insights on how in-hospital
paternity programs can be conducted more effectively. Finally,
we offer some clues on how voluntary paternity acknowledgements
might be made more attractive to less self-sufficient elements
of the unmarried population.
o Jurisdictions should examine their voluntary paternity
acknowledgement procedures with an eye toward
simplification. The key to a successful in-hospital
paternity acknowledgement program is a simplified
administrative process used to put the father's name on the
birth certificate. The Colorado experience is instructive.
Prior to the project, voluntary paternity acknowledgement in
Colorado was cumbersome, time consuming and expensive.
Unmarried parents were required to prepare a birth
certificate without father's name, pay a fee and request an
amended copy. Previously married women were required to
submit a certified copy of their divorce decree before they
could initiate the acknowledgement process. To be valid, all
voluntary acknowledgement forms needed to be notarized.
As a result of the demonstration project (and the subsequent
enactment of two pieces of relevant legislation), the
voluntary acknowledgement process was made more accessible
to unmarried parents. The fee to parents was removed,
divorced parents were treated no differently from other
unmarried women, interested parents could enter the father's
name directly on the birth certificate at the time of birth,
and the requirement for notarized parental signatures on the
paternity affidavit was replaced with the requirement for
witnessed ones.
o Jurisdictions contemplating in-hospital paternity programs
will also have to negotiate with hospitals to gain routine
access to unmarried mothers and their partners. The Colorado
project experimented with child support workers, hospital
social workers and birth registration clerks. There are pros
and cons to using each type of worker. Although child
support workers are enthusiastic and knowledgeable about
paternity and related benefit programs, they cannot provide
the complete coverage that hospital personnel afford and the
arrangement is an expensive one. Hospital social workers are
frequently identified with child protection issues and may
inspire fear and mistrust among certain segments of the
unmarried population. And, although birth registration
clerks are the most logical ones to make the paternity
presentation and complete the affidavit with unmarried
parents, they face pressures to submit the worksheets in a
timely fashion that may compete with the requirement to give
unmarried parents extra time and attention to consider the
paternity option. More critically, in an effort to cut
costs, hospitals appear to be reducing or eliminating the
use of birth registration clerks in favor of having parents
complete birth certificate worksheets and other legal forms
on their own. These trends do not bode well for in-hospital
paternity programs or the quality of vital
statistics-gathering activities.
o In-hospital paternity programs will have to grapple with
several widespread concerns expressed by hospital
personnel. One is the fear that the effort will be viewed as
a "crack down" on fathers and will discourage paternal
participation and/or deter mothers from seeking prenatal
care. Another concern has to do with patient comfort factors
and the growing number of interruptions that newly
delivering mothers experience in their ever-shrinking
hospital stay. Language factors are also potential problems.
Substantial proportions of unmarried parents require foreign
language materials and oral presentations in their native
tongue. Finally, projects must address a variety of
ideological concerns including the sentiment that paternity
has no benefit for women and children and may jeopardize a
woman's safety and her custodial rights.
o Efforts to expose unmarried parents to paternity issues
prenatally suggest that exposure poses particular
challenges. With the exception of teenage pregnancy
programs, unmarried mothers are rarely singled out for
educational and information outreach to which the paternity
overture could be extended. Like married mothers, those who
receive prenatal care tend to get it from private
practitioners or clinics with individual appointment
systems. This makes it impossible to reach a large audience
at one time. Moreover, some hospitals worry about their
image and resist incorporating paternity information in more
general education programs that involve both married and
unmarried parents.
o Child support enforcement agencies must take a lead role in
initiating and sustaining in-hospital paternity programs.
Paternity remains poorly understood by the hospital
community and the general public. Staff turnover in the
hospital world necessitates that paternity be the subject of
frequent training and education programs. In-hospital
programs require brochures, videos and other informational
materials that must be re-stocked. Individual hospitals
require technical assistance to address concerns about
paternity that arise. Finally, to make the issue more
visible in prenatal and postpartum settings, it will be
necessary to conduct a continuous public education effort
and collaborate with relevant community providers.
o To maximize the child support benefits of in-hospital
programs, child support agencies must also amend their
intake procedures. Minimally, intake workers in the child
support enforcement agency must be trained to interview
unmarried parents about their paternity acknowledgement
experiences at the hospital and/or obtain hard copies of
birth certificates in order to elicit more accurate
information. Currently, many cases are improperly
classified because of client failure to appear at the
interview, lax interview techniques and/or client deception.
o In-hospital paternity efforts require strong, positive
relationships between the child support enforcement agency
and the agency responsible for birth certificate records and
vital records agencies. Personnel turnover in the hospital
world is extremely high. In order for in-hospital paternity
programs to be sustained over time, training on paternity
will have to be incorporated into the regular training
programs conducted for birth registration clerks by vital
statistics agencies. Another area of needed collaboration
is informational. To detect special training and technical
assistance needs in hospitals, child support agencies need
regular downloads from vital statistics agencies showing
rates of voluntary paternity acknowledgement by facility.
Finally, in order to maximize on the benefits of in-hospital
paternity programs, child support workers need computerized
access to vital records agencies in order to be able to
visually inspect birth certificates and determine the
paternity status of clients. In light of these areas of
needed collaboration, the wisdom of a recent federal
regulation denying vital records agencies federal
reimbursement for processing statements of paternity is
questionable.
o States must address the ambiguous custody status of
unmarried parents. Many states, including Colorado, fail to
clearly determine who has legal custody of the child in
situations in which the parents of a child are not married
and there has been no determination of custody of the child.
One of the chief objections to voluntary paternity
acknowledgement cited by unmarried mothers was the fear,
whether grounded in fact or not, that the father would take
the child or demand visitation rights. To address this
concern, several states have granted presumptive custody to
unmarried mothers. Indeed, one consequence of the Colorado
project is that a subcommittee working on recodification of
the Colorado Children's Code has recommended automatically
granting legal custody of a child born out-of-wedlock to the
mother until a court orders otherwise. Needless to say,
this is a controversial area of public policy that may
generate strong opposition from fathers. It is also unclear
what impact a maternal custody measure would have on
voluntary acknowledgement levels.
o It is unclear how to make voluntary paternity
acknowledgement more attractive to unmarried parents who are
involved with the AFDC system. Voluntary paternity
acknowledgement rates were significantly higher for those
who were self-sufficient and lower for those who were AFDC
recipients at the time of the birth, especially where the
mother has had several prior children. Whether or not they
signed the paternity acknowledgement form, only about
one-fifth of interviewed unmarried mothers expressed an
interest in formal child support. Moreover, although the
level of support is not known, at least half of the mothers
indicated that the father provided some or full financial
support during pregnancy and that they expected support to
continue. This is corroborated by reports of non-paying,
child support obligors who claim to be providing some
support to their children (Lerman, 1990), with some accounts
suggesting that the irregular, informal support often
exceeds the $50 per month pass through allowed under the
current rules of the system (Watson, 1992). Welfare-dependent
mothers may correctly perceive that their financial situation is
best enhanced by accepting AFDC from the state without formal
child support and supplementing this with informal payments or
contributions from the father (Edin, 1995). It is unclear how to
induce unmarried parents to cooperate more fully with the
paternity and formal child support system. Various policy
changes have been discussed. Among the suggested reforms
are: adopting a Child Support Assurance System, enlarging the
amount of child support paid by fathers that goes to mothers and
babies in AFDC cases, reducing child support order levels for low
income fathers, and coupling the offer to acknowledge paternity
and assume financial responsibility for the child with an offer to
participate in meaningful employment.
Some of these policy initiatives are currently being
explored in other demonstration projects. For example,
several projects in progress aim to combine training and
employment with paternity establishment and child support.
Preliminary information from these projects indicate that
while paternity rates are highest at sites with the highest
job retention rates, the projects are encountering
difficulties in securing good job training slots for absent
parents (Watson, 1992; Bloom and Sherwood, 1994). These
findings underscore the difficulty in achieving a match
between labor market opportunities, the needs of the
unmarried population, and the pressures to increase child
security and decrease welfare dependency.
o The Colorado project demonstrates how difficult it is for
formal policy changes to lead to improvements in child
support outcomes. Increasingly, paternity establishment has
become one of the major functions of the Child Support
Enforcement Program. In response to federal mandates, states
have adopted simple civil procedures for voluntary
acknowledgement of paternity and introduced paternity
establishment programs in hospitals. In theory, these newer
paternity policies should lead to the more expeditious
establishment of child support orders and payments.
In actual practice, however, aggressive paternity
establishment policies appear to have only a negligible
impact on child support outcomes, at least in the short run.
At fifteen months following the birth of an out-of-wedlock
child, couples in the state-run child support system who
voluntarily acknowledged paternity were only slightly more
likely to have a child support order than their disavowing
counterparts (26 percent versus 20 percent). Among parents
with open child support cases, payments were being made in
only 5 percent of cases with voluntary paternity
acknowledgements and 6 percent where parents had disavowed
paternity. As has been the case in many areas of the child
support program (Beller & Graham, 1993), changes in
paternity rules are in and of themselves inadequate to
produce major shifts in child support outcomes.
C. Conclusions
Traditionally, the paternity establishment process began
when the unmarried mother applied for welfare or sought help from
the child support enforcement agency. The timing of these events
was well past the birth of the child and well past the time when
the father was likely to be locatable, attached to the mother
and/or involved with the child. Indeed, research shows that the
effectiveness of establishing paternity declines with every
birthday of the child.
The Colorado demonstration reveals that in-hospital
paternity acknowledgement efforts dramatically enhance the level
of voluntary paternity acknowledgement. The success of
in-hospital programs depends upon the adoption of streamlined
voluntary acknowledgement procedures, aggressive training and
technical assistance outreach efforts in hospitals, and the
cultivation of cooperative relationships with vital statistics
agencies. These relationships are needed to ensure continual
staff training, the distribution of voluntary acknowledgement
affidavits in hospitals, the generation of hospital-specific data
making it feasible to monitor performance in hospital settings,
and automated linkages between vital statistics and child support
agencies so that child support workers can easily view birth
certificates of clients. Although the need for good coordination
between vital records and child support agencies is recognized in
the Omnibus Budget Reconciliation Act of 1993, it is important
that Congress also acknowledge the funding implications of
in-hospital paternity programs for vital records agencies.
While in-hospital paternity programs increase voluntary
acknowledgements among all demographic sub-groups, even those who
have been historically ignored in the paternity establishment
process, voluntary paternity acknowledgement remains most
attractive to the most financially independent elements of the
unmarried population. Moreover, within the fifteen month time
frame of this study, voluntary paternity acknowledgements were
not associated with measurable child support outcomes for those
in the state-run child support system.
In order to generate more substantial child support outcomes
from in-hospital paternity programs, states may have to develop
automated linkages between child support and vital records
agencies. In the absence of these linkages, child support
workers must rely on unreliable techniques like interviews and
manual record reviews to learn whether paternity has been
acknowledged.
It is unclear what must be done in order to attract more
voluntary acknowledgement by the population receiving AFDC or at
risk of needing AFDC. Future demonstration projects should
explore the impact of various policy initiatives like employment
and training programs for unmarried fathers and a Child Support
Assurance System for unmarried mothers on voluntary
acknowledgement rates.
Like many other changes in child support policy, the
Colorado project shows that new rule changes are in themselves
inadequate to produce major shifts in child support orders and
payments. Ultimately, orders and payments depend upon
establishing an obligation, locating an asset or wage and
initiating an appropriate enforcement action with individuals who
often have limited resources and different values. Although
expectations about the financial payoffs of voluntary paternity
acknowledgement should be tempered, it remains a vital first
step. It is hoped that this report will help states take this
step more effectively.
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