Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study
Year: 2023
Type: article
Abstract: OBJECTIVES: 'Healthier Wealthier Families' (HWF) seeks to reduce financial hardship in the early years by embedding a referral pathway between Australia's universal child and family health (CFH) services and financial counselling. This pilot study investigated the feasibility and short-term impacts of HWF, adapted from a successful Scottish initiative. METHODS: Setting: CFH services in five sites across two states, coinciding with the COVID-19 pandemic. PARTICIPANTS: Caregivers of children aged 0-5 years experiencing financial hardship (study-designed screen). DESIGN: Mixed methods. With limited progress using a randomised trial (RCT) design in sites 1-3 (March 2020-November 2021), qualitative interviews with service providers identified implementation barriers including stigma, lack of knowledge of financial counselling, low financial literacy, research burden and pandemic disruption. This informed a simplified RCT protocol (site 4) and direct referral model (no randomisation, pre-post evaluation, site 5) (June 2021-May 2022). INTERVENTION: financial counselling; comparator: usual care (sites 1-4). Feasibility measures: proportions of caregivers screened, enrolled, followed up and who accessed financial counselling. Impact measures: finances (quantitative) and other (qualitative) to 6 months post-enrolment. RESULTS: 355/434 caregivers completed the screen (60%-100% across sites). In RCT sites (1-4), 79/365 (19%-41%) reported hardship but less than one-quarter enrolled. In site 5, n=66/69 (96%) caregivers reported hardship and 44/66 (67%) engaged with financial counselling; common issues were utility debts (73%), and obtaining entitlements (43%) or material aid/emergency relief (27%). Per family, financial counselling increased income from government entitlements by an average $A6504 annually plus $A784 from concessions, grants, brokerage and debt waivers. Caregivers described benefits (qualitative) including reduced stress, practical help, increased knowledge and empowerment. CONCLUSIONS: Financial hardship screening via CFH was acceptable to caregivers, direct referral was feasible, but individual randomisation was infeasible. Larger-scale implementation will require careful, staged adaptations where CFH populations and the intervention are well matched and low burden evaluation. TRIAL REGISTRATION NUMBER: ACTRN12620000154909.
Source: BMJ Open
Authors: Anna M H Price, Natalie White, Jade Burley, Anna Zhu, Diana Contreras-Suarez, Si Wang, Melissa Stone, Kellie Trotter, Mona Mrad, Jane Caldwell, Rebecca Bishop, Sumayya Chota, Lien Bui, Debbie Sanger, Rob Roles, Amy Watts, Nora Samir, Rebekah Grace, Shanti Raman, Lynn Kemp, Raghu Lingam, Valsamma Eapen, Susan Woolfenden, Sharon Goldfeld
Institutions: Royal Children's Hospital, The University of Melbourne, Murdoch Children's Research Institute, University of Wollongong, UNSW Sydney, Sydney Children's Hospital, Ingham Institute, Sydney Children’s Hospitals Network, RMIT University, Uniting, Western Sydney University, South Western Sydney Local Health District, The University of Sydney
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,839
Funders: Glasgow Centre for Population Health, Murdoch Children's Research Institute, University of New South Wales, RMIT University, Ingham Institute for Applied Medical Research, Helen Macpherson Smith Trust, Western Sydney University, Sydney Partnership for Health, Education, Research and Enterprise, National Health and Medical Research Council
OpenAlex ID: W4388895745