When financial coaching was implemented in a pediatric primary care setting, missed visit rates reduced by half which significantly reduced the risk of missed vaccinations, according to a pilot study using LIFT’s financial coaching model and led by UCLA researchers.
The study, published in Pediatrics, is the first to examine the effectiveness of financial coaching and its impact on preventative healthcare in infants’ first six months of life among economically stressed low- income families.
The CDC names strengthening economic supports for parents as a key approach in preventing adverse childhood experiences. This study adds to a growing body of research showing that early interventions against financial hardships and economic stressors for low-income families can have lasting positive effects on the health and well-being of children.
“Recent traumatic events have shown how systems that are supposed to serve, protect, heal, can be detrimental by design in negating the humanity of the individual. Poverty is a public health issue with zip codes determining both mobility and morbidity rates. Medical Financial Partnerships have the potential to demonstrate how cross sector partnerships can improve physical and emotional health of both parents and children by embracing financial health as a healthcare intervention with implications for economic mobility movement at large,” said LIFT-CEO Michelle Rhone-Collins.
“Medical Financial Partnership approaches offer a strategy in improving the continuity and quality of pediatric care, demonstrating higher attendance at infant pediatric visits, lower financial stress, and fewer symptoms of anxiety and depression among parents in the program,” said Helah Robinson, LIFT’s Chief Program and Strategy Officer. She notes that decades of research on the social determinates of health have proven that poverty has long-term physical health and well-being consequences. These consequences are particularly pronounced when the financial hardships are experienced in early childhood. Strengthening economic supports for families is a key approach to preventing adverse childhood experiences and integrating economic mobility coaching into healthcare systems can be the linchpin in addressing financial hardships as a health intervention.
Poverty-related social needs and other patient financial hardships are among the most consistent predictors of missed health care visits. Financial stress can force families to focus on urgent basic needs rather than preventative pediatric care visits, yet interventions to increase patient visit attendance have tended not to focus on the underlying financial needs of children and families. In this new study, conducted at the Harbor-UCLA pediatric primary care clinic and led by lead author of the report Dr. Adam Schickedanz, parents received financial coaching from LIFT-trained coaches in exam rooms during their infants’ well-child visits. LIFT’s training equipped coaches to help parents identify and address their financial goals and strengths and connect them to public benefits and cost-saving services such as low-cost childcare, nutrition assistance programs, free tax preparation, and other public resources. Coaches also followed up with parents remotely at least once a month to support and track progress toward their goals.
Researchers enrolled 81 parents, 35 who were randomized into the intervention group to receive clinic-based financial coaching and 46 in a control group to receive their usual care. This trial found that, compared to the control group, the intervention group that received financial coaching had half the rate of missed pediatric care visits and a 26% increased likelihood of being up to date on immunizations. It also found that the financial coaching group increased their average monthly household income and savings compared to six months after they began the program.
“When we approached the parents in clinic to offer this service and address some of the financial stresses they were juggling, it was clear from their receptive reactions that many already recognized that their finances and health were intertwined. It made sense to from their perspective to integrate this service into their health care,” said Dr. Adam Schickedanz. “The health care system has more contact with children and families in the preschool years than any other family-facing system. This makes health care a great setting for delivering financial guidance and supports to young families.”
The research from this study suggests that “addressing financial goals and needs can improve preventive visit care adherence and vaccinations and partially offset costs to clinics of implementing medical-financial partnership programs, in addition to optimizing the host of health, developmental, and psychosocial benefits of preventive pediatric care,” the researchers write.
The results of this study show that a supportive relationship between a coach and a parent can be the key in giving parents motivation to achieve their personal financial goals as well as sticking with the clinic for their preventative pediatric visits over time. “Strong social connection between parent and coach is an integral part of the success of our direct service,” added LIFT-CEO Michelle Rhone-Collins. “Coaching breaks down the goals of parents into concrete action steps alongside a partner to cheer them on, hold them accountable, and enlivens hope. When social service organizations partner with the medical field, we can build capacity to address the social determinates of health and help break the cycle of poverty lifting two generations at once.”
For further information or questions concerning LIFT’s Medical Financial Partnerships, please contact Helah Robinson at [email protected]
Study authors include Dr. Adam Schickedanz, MD, PhD of David Geffen School of Medicine at UCLA, Michelle Rhone-Collins and Helah Robinson of LIFT, Lorraine Perales and Dr. Peter G. Szilagyi of UCLA, Dr. Monique Holguin of UCLA and USC, Dr. Niloufar Tehrani and Dr. Lynne Smith of Harbor-UCLA Medical Center, and Dr. Paul J. Chung of UCLA and the Kaiser Permanente Bernard J. Tyson School of Medicine.