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

被引：1

作者：

Price, Anna M. H. ^{[1
,2
,3
]}

White, Natalie ^{[1
,2
]}

Burley, Jade ^{[4
,5
,6
,7
]}

Zhu, Anna ^{[8
]}

Contreras-Suarez, Diana ^{[9
]}

Wang, Si ^{[10
]}

Stone, Melissa ^{[11
]}

Trotter, Kellie ^{[12
]}

Mrad, Mona ^{[11
]}

Caldwell, Jane ^{[13
]}

Bishop, Rebecca ^{[14
]}

Chota, Sumayya ^{[15
]}

Bui, Lien ^{[16
]}

Sanger, Debbie ^{[17
]}

Roles, Rob ^{[18
]}

Watts, Amy ^{[1
,2
]}

Samir, Nora ^{[4
,5
,6
]}

Grace, Rebekah ^{[6
,19
,20
]}

Raman, Shanti ^{[6
,21
]}

Kemp, Lynn ^{[6
,19
,20
,22
]}

Lingam, Raghu ^{[4
,5
,6
]}

Eapen, Valsamma ^{[6
,10
]}

Woolfenden, Susan ^{[5
,6
,23
]}

Goldfeld, Sharon ^{[1
,2
,3
]}

机构：

[1] Royal Childrens Hosp, Ctr Community Child Hlth, Parkville, Vic, Australia

[2] Murdoch Childrens Res Inst, Populat Hlth, Parkville, Vic, Australia

[3] Univ Melbourne, Dept Paediat, Parkville, Vic, Australia

[4] Sydney Childrens Hosp Network Randwick, Randwick, NSW, Australia

[5] Univ New South Wales, Womens & Childrens Hlth, Sydney, NSW, Australia

[6] Ingham Inst, BestSTART SWS, Liverpool, NSW, Australia

[7] Univ Wollongong, Ctr Excellence Digital Child, Wollongong, NSW, Australia

[8] RMIT Univ, Sch Econ Mkt & Finance, Melbourne, Australia

[9] Univ Melbourne, Melbourne Inst Appl Econ Social Res, Melbourne, Australia

[10] Univ New South Wales, Psychiat & Mental Health, Sch Clin Med, Sydney, NSW, Australia

[11] Uniting VicTas, Epping, NSW, Australia

[12] Hume City Council, Hume Enhanced Maternal & Child Hlth, Hume, Vic, Australia

[13] Wodonga Enhanced Maternal & Child Hlth Serv, Victoria, Australia

[14] Wesley Miss, Sydney, NSW, Australia

[15] Wesley Miss, Fairfield, Vic, Australia

[16] Child & Family Hlth Serv, Fairfield, Vic, Australia

[17] Child & Family Hlth Serv, Albury, NSW, Australia

[18] Uniting VicTas, Broadmeadows, Vic, Australia

[19] Western Sydney Univ, Ctr Transformat early Educ & Child Hlth, Sydney, NSW, Australia

[20] Western Sydney Univ, Translat Hlth Res Inst, Penrith, NSW, Australia

[21] South Western Sydney Local Hlth Dist, Community Paediat, Liverpool, NSW, Australia

[22] Western Sydney Univ, Translat Res & Social Innovat TReSI, Penrith, NSW, Australia

[23] Univ Sydney, Sydney Med Sch, Sydney, NSW, Australia

来源：

BMJ OPEN | 2023年 / 13卷 / 11期

基金：

英国医学研究理事会; 澳大利亚国家健康与医学研究理事会;

关键词：

mental health; community child health; primary health care;

D O I：

10.1136/bmjopen-2023-075651

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页数：14

共 34 条

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