Socioeconomic status is a dominant determinant of child development and parent health. Children living in poverty are more likely to be born preterm, be chronically ill, experience developmental delay, have cognitive impairment, and have unmet medical needs, all with fewer resources to overcome these challenges.1-3 Parents living in poverty are more likely to have worse overall health, mentally and physically.4 Financial stress is even more widespread than poverty, given that half of Americans are just scraping by financially and lack savings to cover three months of expenses,5 with consequences for child development, adult health, and health care. Financial stress is a root cause of many social determinants of health and common social needs, such as food and housing insecurity, that threaten health. Accordingly, pediatric professional organizations recommend lifting children out of poverty,6 and health systems increasingly address poverty-related social needs in clinical settings where they interfere with health and care.7 Financial services interventions could reduce financial stress directly as a root cause of poverty-related health and developmental hazards. Financial coaching is proven to reduce financial stress using motivational interviewing techniques and standard tools that have been shown to improve savings, reduce debt, and build financial resilience.8 From 2015 to 2017, Dr. Schickedanz and his nonprofit community partner financial coaching organization, LIFT, completed a pilot randomized trial showing that a community-based financial coaching intervention improved health-related quality of life and financial stress among low-income parents receiving services at LIFT offices. Yet community-based financial coaching is underutilized relative to the population in need and could benefit far more low-income families if deployed in clinic-based settings families already visit regularly. Co-locating and coordinating financial services within health systems, termed medical-financial partnerships (MFPs), could address financial, physical, and mental health in concert and impact child development. The effects of embedded financial services in clinical settings have yet to be explored. My mentors, collaborators, and I will 1) study experimental outcomes of a financial coaching intervention plus social needs navigation versus navigation alone on parent health (including mental health), child developmental risk, and social needs in a clinical randomized controlled trial; 2) examine intervention mechanisms of action through qualitative (focus group) and quantitative (mediation and moderation) analyses of relationships between financial stress, social needs, parent self-efficacy, and study outcomes; and 3) assess intervention implementation in a large public pediatric primary care clinic in Los Angeles County. My learning goals in implementation science, qualitative methods, management of research teams and networks will propel these aims, future trials, and my career advancing social determinants of health interventions and understanding the mechanistic links between financial stress and health.
The toxic financial stress of poverty is a key social determinant of health during childhood and over the lifecourse and The American Academy of Pediatrics and The National Academy of Medicine recommend integrating programs that address financial stress and other social determinants with health care delivery. My mentors, collaborators, and I will 1) study experimental outcomes of a financial coaching intervention plus social needs navigation on health-related quality of life (including mental health), child developmental risk, and social needs in a clinical randomized controlled trial; 2) examine intervention mechanisms of action via analyses of relationships between financial stress, social needs, parent self-efficacy, and study outcomes; and 3) assess intervention implementation in a large public pediatric primary care clinic in Los Angeles County. My learning goals in implementation science, qualitative methods, management of research teams and networks will propel these aims, future trials, and my career advancing social determinants of health interventions.
