Impact of a Medical-Financial Partnership Intervention on Parent Mental Health, Perinatal Outcomes, and Child Developmental Risk: A Community-Partnered, Multi-Site Randomized Trial

PROJECT SUMMARY & ABSTRACT Poverty drives inequities in parent health, birth outcomes, and child development, but financial interventions in health care are rare. Low income and financial stress increase mental and physical health risks, chronic illness, preterm birth, child developmental delay, and unmet medical needs. Given that half of Americans report living paycheck-to-paycheck, financial stress is common, especially in pregnancy and infancy, with disproportionate impacts on marginalized communities and population-wide consequences for adult health and child development. While the National Academy of Medicine recommends health systems address poverty-related social needs in clinical settings, some medical professional organizations have gone further to recommend anti-poverty income and financial supports as health interventions. This has led to growth of Medical-Financial Partnerships (MFPs), which are cross-sector service collaborations of medical and financial professionals to reduce poverty and financial hardship directly as an upstream cause of health risks. Financial coaching improves income, savings, debt, and financial stress using standard tools and techniques similar to motivational interviewing applied to supporting clients’ financial goals, but its reach could be much greater if integrated with clinical care, which nearly all infants and parents routinely access. Our team, including the national nonprofit financial coaching organization LIFT, completed a community-partnered pilot randomized trial of clinically-integrated financial coaching in a single pediatric clinic that improved parent mental health, preventive visit adherence, and income, as well as potentially reducing child developmental delay risk. Because financial stability in pregnancy protects maternal mental health and child development, the pediatric MFP intervention’s health impact could be even more effective if begun during prenatal care. We propose a multi-clinic randomized clinical evaluation of the impact of clinically-integrated financial coaching on perinatal and postnatal parent mental health and health-related quality of life, infant low birthweight, child developmental delay, health care adherence, family income, and public benefits use. We will examine the MFP intervention’s mechanisms by exploring timing and mediation effects across the pregnancy and newborn periods while assessing implementation factors influencing its success. We will partner with clinics in the Los Angeles County Department of Health Services network, the second largest public health care system in the US. This community-partnered study will continue our collaboration with LIFT, a national nonprofit financial coaching organization, to inform the intervention, as well as a national external advisory MFP Learning Community for insights on implementation and dissemination. We anticipate this study will advance the field of clinical interventions addressing social and economic drivers of health, providing evidence on an innovative approach to reduce inequities in mental health and child development.