Longer Term Impact of a Randomized Medical-Financial Partnership Intervention on Child Developmental Risk, Parent Mental Health, Health Care Utilization, and Public Benefits Program Use

PROJECT SUMMARY & ABSTRACT Poverty is a dominant driver of health outcomes, development, and health care utilization in childhood, throughout the life course, and across generations, but anti-poverty interventions in health care are rare. Poverty increases risks of child developmental delay, mental and physical illness, and unmet medical and social needs. Despite the availability of public anti-poverty programs, financial stress is common, with over half of families with kids living paycheck-to-paycheck, and its disproportionate impact on low-income, economically-sidelined communities has population-wide consequences for child development and adult health. Financial stress is a root cause of many social drivers of health and health-related social needs, such as food and housing insecurity. Accordingly, the National Academy of Medicine recommends health systems address poverty-related social needs and medical professional organizations have gone further to recommend anti-poverty programs as part of health care. This has led to a nascent field of cross-sector interventions integrating financial services into clinical care, termed Medical-Financial Partnerships (MFPs). Financial coaching is proven to reduce poverty and stress using motivational interviewing techniques and standard tools that improve income, savings, debt, and financial resilience. Our MFP team, including the national nonprofit financial coaching organization LIFT, are close to completing a community-partnered pilot randomized trial of clinical financial coaching in pediatric care that has already improved income, parent mental health, and adherence to preventive visits, with promising changes seen in child developmental risk. Because financial stability in infancy can improve child development and life course health years later, our MFP intervention impact likely extends past the initial study period set to end when the children reach age 2. We propose to evaluate longer-term outcomes in child development, parent health, health care utilization, and household use of cross-sector government services as a result of this clinically-integrated MFP financial coaching program. In addition, we will examine the MFP intervention’s mechanisms of impact over time while exploring its interplay with a host of family-facing public governmental programs. We will partner with the Los Angeles County Chief Information Office to link our directly collected study data with data detailing participants’ use of a comprehensive set of government agencies and services spanning the nation’s most populous County. This study will continue our collaboration with LIFT, a nonprofit financial coaching community partner organization, as well as a national external advisory MFP Learning Community for dissemination of findings and scalable best practices. We anticipate this study’s longitudinal findings will advance the social drivers of health field and inform pediatric health care in the context of the cross-sector family service ecosystem to improve population health outcomes and child development.