5

Barriers to Effective Policy Implementation

This chapter draws substantially from the research paper “A Comprehensive Literature Review of Caregiving Challenges to STEMM Faculty and Institutional Approaches Supporting Caregivers,” by Joya Misra, Ph.D., Jennifer Lundquist, Ph.D., and Joanna Riccitelli, which was commissioned for this study.¹

While many potential policies and programs exist to support family caregivers, a range of barriers to effective implementation remains. Poor policy implementation, unintended consequences, and policies that are implemented but not sustained over time can serve to undermine the efficacy of policies for caregivers in science, technology, engineering, mathematics, and medicine (STEMM). This chapter highlights six barriers to successful policy implementation and use: (1) affordability, (2) availability, (3) lack of awareness, (4) lack of attention to intersectionality, (5) lack of institutionalization, and (6) cultural beliefs and biases. The committee acknowledges that institutional context varies greatly and certain colleges and universities may encounter challenges and constraints not mentioned here. The goal was to focus on issues that cut across contexts and may be experienced by most institutions when implementing caregiving policies.

AFFORDABILITY

While in many countries families receive subsidized or free childcare and other resources, in the United States, families carry the financial burden of care (Garfinkel et al., 2010). Financial costs of care can be a barrier to policy access for individuals in academic STEMM who may not be able to afford the support they need without heavy subsidies. Potential costs can also be a barrier to implementation because universities looking to cut

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¹ The full paper is available at https://nap.nationalacademies.org/resource/27416.

spending or balance budgets may be worried about upfront costs associated with certain policies.

One example that is frequently central to debates about costs of family caregiving in the United States is the provision of paid care, such as childcare or adult care centers or home aids. While universities may offer subsidies or provide on-site childcare (adult care is much less common) and some funders offer grants to cover some costs associated with care, financial barriers can impede how effective these resources are for individuals, as well as the likelihood of universities instituting or expanding support. First, looking at individual affordability, existing care on college campuses is rarely subsidized, and the cost often exceeds what the U.S. Department of Health and Human Services designates as affordable given the average faculty salary (Dolamore et al., 2021). Groups within STEMM who are outside the tenure track, such as students, trainees, and staff, can struggle even more without subsidized support given their income levels. In a letter sent to the National Institutes of Health detailing challenges faced by postdocs with children, the letter writers analyzed data on average housing and childcare costs in cities across the country. Their results found that the cost of rent and care often exceeded 30 percent of income in a two-postdoc household, and in extreme cases, amounted to more than 75 percent of income, especially for those with more than one child (Guo et al., 2023). The challenges of affordable care also extend well beyond universities, as costs for childcare and long-term care are soaring nationwide (Abelson & Rau, 2023; DeParle, 2021). Given all of this, without affordable care, the provision of care alone is not enough because many in academic STEMM will not be able to access what they need within their means.

At the same time, providing and subsidizing childcare represents a large upfront cost for universities, and this may hinder willingness and ability to provide as much support as caregivers need. This is especially challenging in a setting where there have been declining public investments in universities, creating a greater pinch for those institutions that are already financially constrained (Marcus, 2019). Unfortunately, limited peer-reviewed data exist on how university administrators make decisions about policies and programs to support caregivers based on budgets and costs. Given this limited literature, the committee sought input from those at the forefront of implementing these kinds of programs through conversations with Sherry Cleary, former dean of the Office of Early Childhood Initiatives at the City University of New York, and with leadership from the National Coalition

for Campus Children’s Centers.² All emphasized the unique value of on-site campus childcare as a powerful recruitment, retention, and research tool. They noted that when programs were reliant on single sources of funding, they were especially at risk. Dr. Cleary specifically noted: “Programs have to demonstrate their integral alignment to the mission of the university, and if they can’t provide detailed cost-benefit analyses of this, essential service programs can be at risk when campus budgets are challenged.”

Ultimately, while policies like on-site care and subsidies can have long-term cost-saving benefits for universities and are important for individuals to be able to continue their work and education in academic STEMM, the costs of supportive care policies can pose a barrier to access, implementation, and expansion.

AVAILABILITY

Availability is another key barrier to policy efficacy, as existing policies may be limited in scope in ways that present challenges for family caregivers. The provision of paid care is again a useful example of these issues. On-site childcare would help students and academic STEMM faculty and staff access quality care for their young children at or near their workplace, yet on-site childcare is rare among private U.S. employers (Galinsky et al., 2008), and no representative survey of colleges and universities has assessed how many campuses provide childcare subsidies or on-site care. However, recent surveys of specific academic fields suggest the number may be higher in some areas of academia, but coverage is uneven (Dolamore et al., 2021; French et al., 2022). Additionally, an analysis of community colleges and public universities in 36 states found substantial declines in campus childcare between 2002 and 2015 (Eckerson et al., 2016). Moreover, when on-site care is available, full-time slots are not always offered (Dolamore et al., 2021). And many care centers have extensive waiting lists given much higher demand than they can meet. Significantly, research suggests that the availability of on-campus childcare has been declining at the same time that the population of students with children is increasing across all institution types, compounding challenges of availability (Noll et al., 2017).

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² These conversations took place over Zoom on July 3, 2023, with Dr. Cleary and on July 13, 2023, with representatives from the National Coalition for Campus Children’s Centers. The committee engaged these experts given their extensive experience in building and growing childcare centers on university campuses and the challenges of doing this.

Issues of childcare availability came up frequently in interviews as well. Indeed, the inadequacy, inaccessibility, or effective unavailability of institutional childcare supports was a subject of widespread critique among the study sample—perhaps because interviewees so desperately needed these services, as articulated in the quotes below:

Of course, on-site childcare is just one of many availability issues regarding care resources. Childcare provisions may still be less robust than necessary, but older adult care is even less common. The committee could not identify any comprehensive reviews of the provision of adult care on campuses. In addition, finding examples of this in practice proved difficult, though they found one promising practice for providing adult care at Virginia Commonwealth University (see Chapter 6). Given the relative lack of attention to the needs of caregivers of adults relative to caregivers of children, a key gap remains in availability of the kinds of supports caregivers of adults need that those caring for children may be better able to access. In interviews, many respondents spoke of challenges with access to older adult care. As one respondent noted:

LACK OF AWARENESS

Lack of awareness of existing caregiving institutional policies remains a key barrier to use and efficacy of family-friendly policies in academic

STEMM. No matter how beneficial or supportive a policy or practice might be, it cannot have its fully intended effect if people are not aware of its existence, their rights to access it, or how to access what they need (Calvano, 2013; Dembe & Partridge, 2011). Multiple studies have identified a lack of awareness about caregiver policies among STEMM employees. For example, in a 2015 study of faculty at a large research institution, 91 percent indicated they were unaware of their university’s policies and procedures for older adult care (Leibnitz & Morrison, 2015). Similarly, a 2023 study of ophthalmologists found that three-quarters of those surveyed did not know whether their workplaces had stop-the-clock policies for tenure (Kalra et al., 2023).

One reason for lack of awareness may be simple challenges of knowing where to find information on particular policies and eligibility criteria. In the 2015 study of faculty at a large research institution noted above, many respondents reported difficulty finding the information they needed (Leibnitz & Morrison, 2015). (Chapter 6 provides examples of institutions that have developed websites and offices that make it easy to find existing resources.) Another barrier to awareness and access comes from supervisors and department chairs, who often serve as gatekeepers to policy access even when they are not required to approve a particular benefit (Shauman et al., 2018). Chairs and supervisors taking on this role are themselves not always aware of what policies stipulate and may misdirect those they are intending to guide. Shauman et al. (2018) note that this underscores the need to train department chairs and other supervisors so that they are aware of policy details and why facilitating access to these policies is so important.

Lack of awareness could have substantial consequences, as evidenced in interviews. Students and other early-career scholars reported great difficulty accessing even basic caregiving supports, such as postdelivery recovery time and parental leave or tenure clock adjustments because of awareness issues. It was not unusual among interviewees to learn of available formal supports after the point at which it would have been helpful to access them, leaving them completely without support. Students often did not know what they were entitled to or were reluctant to ask. As one respondent shared:

And interviewees also recounted challenges created because of a lack of awareness among those who were supposed to be guiding them. In some cases, administrators were not sufficiently knowledgeable about what was available or permissible to be helpful even when approached for assistance. For example, a graduate student who left academic STEMM due to the financial pressures she faced as a caregiver for her grandmother recounted:

Any policy can be effective only if it is used, and lack of awareness can pose a substantial hindrance. Without clear documentation online and clear communication to department chairs and others who may serve as gatekeepers to policy access, students, faculty, and staff can remain uninformed about the support available to them. And, as is discussed later in this chapter, cultural beliefs and biases can lead to a fear of being stigmatized for utilizing caregiving resources, resulting in concerns among caregivers in reaching out to receive the information they need (Shauman et al., 2018).

LACK OF ATTENTION TO INTERSECTIONALITY

Policy effectiveness is also hindered by a lack of attention to intersectionality, which can lead to unintended consequences that leave out women of color and other groups with intersecting marginalized identities. Because Black, Hispanic, and Native women as well as LGBTQ+ women or non-binary people often represent incredibly small numbers across academic STEMM disciplines, their experiences and needs frequently get lumped together into the broader category of women or dropped from analysis. Doing this, however, ignores the heterogeneity among women and has the potential to lead to policies that may be effective for White women, but are ineffective or insufficient for others (McAlear et al., 2018). As Kossek, Lautsch, et al. (2023) argue, intersectionality means that even if institutions put in place some caregiving supports, some groups may not be able to

access these supports, with these effects particularly salient for those from more disadvantaged groups.

For example, definitions of “family” influence how leave policies are written and implemented. As noted in Chapter 3, family caregiving is not the same for everyone, and it varies by race/ethnicity as well as immigrant and LGBTQ+ status. While White Americans are more likely to provide care for those within the nuclear family unit, immigrants and Americans of color are much more likely to provide care for an extended network of family, kin, and community (Gerstel, 2011; McCann et al., 2000; Sodders et al., 2020; Tam et al., 2017). Research has shown this broader definition of family is also more common among LGBTQ+ individuals (Biblarz & Savci, 2010; Weston, 1997). When policies and programs are constructed around White, heteronormative assumptions of a narrow definition of family caregiving, this presents challenges for those who do not subscribe to this. For example, caregiving leave policies are often provided on an individual, ad hoc basis (Roselin et al., 2022), which leaves them open to potential bias and normative assumptions of who needs such policies and for what purpose. Policies may be written such that leave is granted only to those caring for the needs of an immediate family member. And even if policies apply to a broader definition of caregiving and are being shared by well-intentioned department chairs advising faculty members or faculty advisors assisting students, chairs and advisors may still implicitly assume that family leave is not as expansive. This can hinder access for those taking on care responsibilities of individuals to whom they are not directly related. Attention to intersectionality is necessary to ensure policies, programs, and resources have the greatest effect for all those who make use of them.

In interviews, caregivers of color frequently discussed the ways in which implicit assumptions and biases from the dominant White culture clashed with how they understood family caregiving in ways that created greater challenges for them and produced barriers to feeling fully supported by present policies. As one caregiver of color noted:

Along with failure to fully support caregivers with intersecting marginalized identities, a lack of attention to intersectionality can fail to account for all possible care recipients. An example was shared in interviews where a parent discussed the challenges of trying to utilize policies that were not made with children with disabilities in mind:

While the policy attempted to provide paid caregiving support to help parents manage a child’s sickness, implicit assumptions that did not account for those sick children also having disabilities or developmental challenges left the parents of these children without access to support.

LACK OF INSTITUTIONALIZATION

Another barrier to ensuring access to effective policies for family caregivers is ensuring that effective policies remain in place. There has been less academic research in this area, as much of the evaluation literature focuses on how policies operate when implemented, not what happens after implementation to ensure policies remain. Here, the committee drew on examples to inform its discussions and highlight how this can hinder positive interventions.

One such example is the time-banking system instituted by the Stanford University School of Medicine (discussed in more detail in Chapter 7). The program, which was started as a pilot in 2012 across several clinical

and basic science departments, allowed medical faculty to “bank” time spent on work such as mentoring or covering another colleague’s shift that is not typically as highly valued in the field. This banked time could then be used as credit to get back time for academic activities including grant writing support, but most importantly for family caregivers, for “home-support activities” (Berg, 2018; MacCormick, 2015). Along with piloting the program, researchers also conducted a multiyear study to assess its efficacy. The study found many benefits to the program, namely, improved perceptions of flexibility and wellness as well as greater institutional satisfaction. The authors also found that compared with a matched sample of nonparticipants, those who participated in the program received 1.3 times more grant awards, totaling around $1.1 million in funding per person (Fassiotto et al., 2018). Despite these benefits, however, the program has been retained only in the Department of Emergency Medicine as of 2022. A policy established under one dean that was successful across each of these different metrics, in both employee perceptions and grant outcomes, was not successfully institutionalized and, as a result, was discontinued after that dean stepped down.

To the committee’s knowledge, no research currently exists explaining the reasons why this policy or others like it did not continue; however, some literature examines sustainability of organizational change that can provide insight into why and how it is that policies either remain in place or fade away. The forces affecting policy staying power operate at multiple levels and encompass factors ranging from issues of timing, leadership, managerial support, individual challenges, cultural conflict, organizational and procedural barriers, and outside influences from external events (Buchanan et al., 2005).

One of the key barriers to policy staying power, however, is when a policy fails to become integrated into the structure of an organization, that is, when it fails to become institutionalized. Policies tied to groups or individuals who champion them rather than to institutional units or positions that exist beyond any individual are less likely to remain intact, especially if their champions leave the organization (Wynn, 2019). Even policies that have demonstrated positive outcomes, positive media attention, and interest from other organizations looking to implement something similar have been documented to phase out following the departure of their main backer when they were not effectively built into the structure of the institution (Wynn, 2019).

There is no guarantee that effective policies remain, and anecdotal evidence in universities and research in other domains suggest that this can

be a substantial challenge. In particular, without institutional support and ensuring that policies and programs become a part of the structure of the university, good policies may not last as long as they should.

CULTURAL BELIEFS AND BIASES

Some barriers are grounded in deeply embedded systems in colleges and universities. As noted in Chapter 3, academic STEMM has a core cultural assumption that single-minded devotion to work is an indicator of scientific merit, and this cultural assumption is institutionalized into many standard policies and practices, including full-time, time-intensive tenure clocks and productivity metrics that do not consider periods spent focused on caregiving (Blair-Loy & Cech, 2022; Blair-Loy et al., 2023). A challenge to the introduction of new policies is ensuring cultural change to go along with it, as this helps them to become embedded within the institution. It also helps ensure people do not fear stigma or backlash or face biased and discriminatory treatment for using them (Kachchaf et al., 2015; Kossek & Lee, 2022; Sallee, 2012; Williams, 2005, 2014; Williams & Norton, 2010).

Although flexible work scheduling norms have not made the same inroads into the academic setting as they have in some firms and corporations outside academia, such arrangements have made a major difference for the success of employees in these other settings (Christensen, 2013). As such, scholars have suggested variations within academia, such as the half-time tenure clock that operates on a 12-year track (Drago & Williams, 2000; Moors et al., 2022; Ward & Wolf-Wendel, 2012). Certainly, the precedent of the pandemic has sparked a shift in the way that tenure delays are viewed and accepted as well as instigated tenure clock extensions for all faculty at many institutions (Smith et al., 2022). However, so long as standards for and measures of success in academia remain unchanged—for example, a reliance without question or contextualization on metrics known to have bias, such as citation indices, as well as excessively high expectations of publication numbers—and ideal worker norms and expectations of workplace devotion remain entrenched, caregivers who opt for these pathways will continue to fall behind in academia. And, indeed, many faculty who have engaged in these practices have been disadvantaged in terms of promotion and tenure (Williams & Norton, 2010). Ultimately, cultural biases and flexibility stigma create a disincentive to use flexible policies, resulting in the uneven uptake seen among STEMM faculty (Lundquist et al., 2012; Morgan et al., 2021; Sallee, 2012). Concerns

about this stigma may be part of why most faculty members on modified duties or parental leave continue to engage in research and mentoring if they can (Lundquist et al., 2012).

Cultural change is challenging; however, the COVID-19 crisis put into motion a series of shifts that challenged conventional practices in higher education. Indeed, some used it as an opportunity to recalibrate the approach to the standards used to evaluate productivity and effect. As one example of broader efforts to promote cultural shifts during the pandemic, a team of researchers called on the field to reinvent promotion and tenure practices by, for example, advocating for the use of alternative impact metrics, such as “communication, community-based implementation, dissemination (e.g., Altmetric scores), effective mentoring, and advocacy work” (Cardel et al., 2020). Yet, while the pandemic shifted the paradigm in several ways, the innovations universities adopted have so far failed to fundamentally change the criteria for tenure and promotion. In a study of pandemic policies, less than 1 percent of the top 386 U.S. universities modified their tenure and promotion evaluation expectations in some way (e.g., to note that quality over quantity would be considered for evaluation or that other duties besides research would be given more weight) (Culpepper & Kilmer, 2022).

Cultural beliefs and biases can discourage use of available work-life supports, including more quotidian ones like paid time off, as evidenced in interviews:

This highlights the steep barriers cultural biases create for policy success. Even in the face of a global pandemic, entrenched norms are still held in many instances. It may take time and creativity, but effective policy implementation needs to work to break down these norms and develop new norms that value flexibility and recognize and embrace the outside

lives of those in academic STEMM, including their caregiving responsibilities. Efforts that normalize flexibility and outside obligations through support for institutional and departmental leaders, greater visibility and acknowledgment of caregiving, and policies that center work-life inclusion are important for overcoming cultural barriers.

SUMMARY OF FINDINGS FROM CHAPTER 5

Policies that provide needed support to caregivers are not always as effective as they could be and may even fail to be implemented or sustained. Understanding these barriers is crucial to designing effective policies that consider potential pitfalls and aim to address them. In Chapter 6, we draw on knowledge of these barriers as well as existing evaluative research to outline foundational and promising practices to support family caregivers in academic STEMM.

1. Even effective policies may fail to be implemented, expanded, or continued given barriers that affect utilization, awareness, and practicality.
2. The upfront costs associated with certain policies, such as childcare provisions, can be a barrier not only to individuals who may not be able to afford quality outside care but also to institutions looking to add or expand offerings for caregiving on campus.
3. Availability of paid care is a challenge for many in academic STEMM and many Americans more generally. There have been declines in care centers on campuses over time while there has been a rise in certain populations, such as students, with children, creating even greater availability challenges for on-site childcare options.
4. Across multiple kinds of policies, people are simply not aware of what their universities offer, making it harder for them to make use of policies and programs they could access.
5. Without considering intersectionality, policies may produce unintended consequences that leave out women of color, socioeconomically disadvantaged, and other groups whose experiences and definitions of family caregiving do not fit dominant norms and assumptions.
6. Cultural biases, particularly flexibility stigma, can make it difficult for people in academic STEMM to utilize family-supportive

6. policies for fear they will be seen as less committed and dedicated to their work.
7. Policies that are not fully institutionalized but instead championed by one person or one group risk being discontinued if the policy champions leave the organization.

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