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Muriel Rice teaches clients in the UT Health Works program

Helping women overcome barriers and realize their potential is what gets Muriel Rice out of bed in the morning. Director of the University of Tennessee (UT) Health Works program, a job training assistance program for welfare recipients, Rice has been instrumental in bringing healthcare assessment into the curriculum that helps women gain independence from welfare and become self-sufficient.

“Long term employment is a challenge,” Rice said. “We think health issues are a major impediment.”

For years UT has worked with the Department of Human Services and Seedco (Structured Employment Economic Development Corporation) to provide job training for welfare recipients, but it wasn’t until April 2006 when Rice came on board as director that health promotion and intervention were incorporated into the program.

“The more I worked with (Health Works clients) and saw the neglect in this underserved population,” Rice stated, “I wanted to get this issue adequately addressed.”

Women go into different tracks based on their skill and education level. They’re given a case manager who enrolls them into job development, job training or a vocational track. Typically clients are trained for clerical positions and learn basic business etiquette and general office tasks such as operating computers. Along with skills assessment and interviews to determine career interests, women who enter Health Works are given a health risk appraisal which is used to identify health risk factors that can impede their ability to get work and moreover, retain long term employment.

While Rice and colleagues have collected evidence-based research to justify the implementation of interventions on a wide scale, the challenge is garnering financial support.

“My goal is to is to involve all four Seedco partners and address everybody in Shelby County,” she said. UT is the only site currently offering health appraisals and counseling. “There’s money out there for a lot of different causes but this one, I feel, has been really neglected.”

According to a 2003 report from the Society for Social Work and Research, even if welfare recipients obtain employment, those with health problems have a 57 percent increased likelihood of job loss.

“Some of them have not worked for long periods of time and getting back into the workforce is a challenge,” said Rice.

The majority of welfare recipients in the United States are single women with children, 39 percent of which are black. In studies published by Rice and UT nursing professor Mona Wicks, data indicated 98 percent of those entering UT Health Works are single black mothers between the ages of 18 and 34. What was significant, although not unexpected, were findings that 71 percent of women had mild to severe depressive symptoms. Obesity is also a major problem (70 percent), along with poor nutrition, physical inactivity and cigarette smoking, as well as an overall underutilization of healthcare services.

Depressive symptoms can include, Rice explained, an inability to focus, inability to sleep and negativity which can produce a range of somatic symptoms like, “not feeling well, vague headache, not feeling like going to work today,” Rice added. “They don’t even realize those are depressive symptoms.”

Retention is the biggest challenge for the Health Works program. Psychological and emotional barriers make it difficult for women to pull themselves out of welfare dependency and into gainful employment. While no diagnoses are given during a health appraisal, health education is offered and if a problem is noticed, participants are referred to their healthcare provider. By addressing depression and depressive symptoms, maintained Rice, these women could, “have a higher level of critical thinking and problem solving as to how they could get around some of the other issues.”

Since July 2007, more than 2,700 women have been evaluated through the program. Felecia Edwards is a graduate of the program and currently works as a control clerk for the UTHSC College of Dentistry.

Edwards said before she entered the program she usually sat around at home.

“Some people don’t even have family to lean on, they don’t have anybody to motivate them, and this is what this program does – helps them find out where they are in life and what career they want.”

Rice is married with two grown children. Now Health Works is her baby. Rice began her journey into nursing in 1990 after teaching at the UT College of Nursing. Originally a basic science professor at Le Moyne Owen College, Rice said her experiences while teaching nurses inspired her to make a greater impact on the community. In addition to her Health Works directorship, she practices once a week at Planned Parenthood. There, she witnesses a constant reminder of the problem with access to primary healthcare.

“There are so many women coming in now thinking this can be their major source of healthcare,” she said. “If we want to reduce the burden of the medical cost related to the working poor, we (have to) to teach them to take care of themselves.”

Learning to rely on community resources is a key element of the program. Clients understand the Health Works program is not a crutch, and though it’s an uphill battle, some women are coming out stronger.

“I definitely want to make a difference and I take my success in small doses,” Rice said, insisting she won’t feel comfortable retiring until more emphasis is focused on health interventions for this population. “It’s validated for me everyday that this is needed and that it’s helping the client.”


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May 2008

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