Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study

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...

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Published in:	BMJ open Vol. 13; no. 11; p. e075651
Main Authors:	Price, Anna M H, White, Natalie, Burley, Jade, Zhu, Anna, Contreras-Suarez, Diana, Wang, Si, Stone, Melissa, Trotter, Kellie, Mrad, Mona, Caldwell, Jane, Bishop, Rebecca, Chota, Sumayya, Bui, Lien, Sanger, Debbie, Roles, Rob, Watts, Amy, Samir, Nora, Grace, Rebekah, Raman, Shanti, Kemp, Lynn, Lingam, Raghu, Eapen, Valsamma, Woolfenden, Susan, Goldfeld, Sharon
Format:	Journal Article
Language:	English
Published:	London British Medical Journal Publishing Group 22-11-2023 BMJ Publishing Group LTD BMJ Publishing Group
Subjects:	Caregivers Children & youth community child health Counseling services COVID-19 Design Financial counseling Health services research High income Industrialized nations Mental disorders Mental health Mixed methods research Pandemics Poverty primary health care Australia New South Wales Australia
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Summary:	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.MethodsSetting: 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.Results355/434 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.ConclusionsFinancial 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 numberACTRN12620000154909.
Bibliography:	Original research ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	2044-6055 2044-6055
DOI:	10.1136/bmjopen-2023-075651