Financial, physical, and mental health are inextricably intertwined. In California, economic and health inequities coincide in historically vulnerable communities that have experienced centuries of underinvestment and discrimination. Addressing these social, structural, and economic determinants of health for low-income, historically-marginalized expectant mothers, their children and families is especially urgent, given the challenges they face with convergent crises of the post-COVID economy, rampant social isolation and family adversity, and the structural violence of racism that demands institutional change for economic justice. Healthcare systems will need to move beyond simple screening and referral for extremes of food scarcity, housing insecurity, and other social needs – the symptoms of underlying economic injustice and poverty – to fundamentally treat poverty and toxic financial stress itself as a health hazard.
LIFT-Los Angeles has partnered with Drs. Adam Schickedanz and Monique Holguin at UCLA and the Los Angeles Department of Health Services (LADHS) to build and expand the Medical Financial Partnership (MFP) model. The model directly addresses the social and economic determinants of child and family health, and aims to increase child and family structural, social, and early relational support through addressing poverty and financial stress. LIFT-LA provides the technical assistance, training, and ongoing support needed for coaches to deliver comprehensive financial coaching—all co-located and integrated within the LADHS clinics’ core medical services. The clinic is an academically affiliated safety net women’s health clinic in Los Angeles County which serves predominantly low-income, Hispanic/Latinx and Black/African American patients that are entirely Medicaid-insured or eligible. Through this innovative MFP model, LIFT-LA has gained unique insight into what it takes to adapt LIFT’s holistic model and how financial coaching can be integrated into the pediatric and prenatal clinical setting to address the social, structural, and behavioral determinants of child and family health.
This past year, the MFP served a total of 395 families and demonstrated substantial financial and health benefits, including higher monthly income, improved mental health symptom scores, and increased savings for families. Within one year of enrollment in the program, the average increase in income was $830 per month, the average increase in savings was $918, and average debt reduction was over $1382 (among all individuals in the program, not just those who had debt). Just over 70% of financial coaching participants had an increase in income, a similar proportion maintained or increased their savings, and just over half either reduced their debt or did not go into debt. In addition, we found an improvement in parent intervention participants’ mental health (i.e. depression and anxiety) symptom scores by six months post-enrollment in the financial coaching program.
The MFP has also served roughly 7,000 families through the development of the Benefits Explorer Tool, which provides parents of pediatric patients with information and a one-stop online portal for anti-poverty public benefits programs that all clinic families qualify for by virtue of their children’s Medicaid enrollment. As a result of the financial coaching program 48% more families in the program became newly enrolled in WIC compared to families receiving usual care. Similarly, as a result of the financial coaching program, an additional 33% of families became newly enrolled in SNAP and an additional 61% of families in the program became newly enrolled in childcare subsidies compared to families receiving routine care.
Results of the MFP’s work regarding early clinic visit attendance rates received national media attention, garnering multiple segments on National Public Radio’s All Things Considered, Weekend Edition, and NPR’s Shots health web articles, linked here. The findings of the study were published in Pediatrics and LIFT hosted a special webinar event to disseminate the findings. Additional media interest in the program has continued, with local reporters from ABC7 in Los Angeles reaching out to the MFP Co-Directors for a follow-on story to highlight the MFP program’s innovative approach.
In the future, the MFP model is poised to expand, with the LA County Department of Health Services – the nation’s second largest public health care system – interested in supporting the model as a new standard for addressing various forms of childhood adversity driven and exacerbated by poverty. This partnership is determined to address major drivers of poor healthcare outcomes, and to train the next generation of social workers to create holistic services within healthcare settings. Ultimately, through this partnership, we hope to positively impact childhood social determinants of health and increase competencies within healthcare systems to become more responsive to families’ needs.