Connecting Families: Primary Care Poverty Screening & Financial Support Navigation for Families of Young Children

Context: Family poverty is associated with poor health outcomes in parents and children and remains prevalent in Canada. Healthcare providers are encouraged to screen for poverty but evidence on the effectiveness of social interventions and the role of health professionals are limited. Community Support Workers (CSWs) have a thorough understanding of potential income supports and community support agencies.

Objectives: To evaluate the feasibility and potential effectiveness of financial support navigation with a trained CSW.

Study Design and Analysis: Pilot RCT. Between-group differences in outcomes were assessed using ANCOVA adjusting for baseline score and linear mixed effects models adjusting for baseline score, child age, and sex.

Setting: Primary care practices, early years centres and a social assistance office.

Population: Families of children aged 2-5 years endorsing the screening question “Do you ever have difficulty making ends meet at the end of the month?”

Intervention: A structured review of families’ financially related needs and resources with a trained CSW, and support to identify and meet their goals. All families received a written summary of available resources.

Outcome measures: Feasibility outcomes were rates of recruitment and questionnaire completion; preliminary effectiveness outcomes were child social-emotional development, using the Strengths and Difficulties Questionnaire (SDQ) and parenting stress, using the Parenting Stress Index (PSI).

Results: 37 caregiverchild dyads were randomized and outcomes were assessed on 29 participants at 6 months and 22 participants at 12 months. Using ANCOVA, the mean between-group difference in SDQ Total Difficulties Score at 6 months was -1.21 (95% CI -3.82, 1.40, p=0.35), at 12 months was 1.10 (95% CI -3.13, 5.34, p=0.59) and PSI Total Score at 6 months was -12.88 (95% CI -21.63, -4.12, p=0.006) and at 12 months was 7.79 (95% CI -4.42, 20.00, p=0.20). Using linear mixed effects models, the mean between-group differences in SDQ TDS was -1.09 (95% CI -3.81, 1.63) at 6 months and 1.08 (95% CI -2.87, 5.04) at 12 months and PSI Total Score was -10.73 (95% CI -19.83, -1.64) at 6 months and 8.41 (95% CI -2.98, 19.79) at 12 months.

Conclusions: Recruitment of families living in poverty and data collection were feasible. Families receiving CSW support experienced reduced parenting stress at 6 months compared to those receiving usual care but there was no difference in child social-emotional development.