431 - Feasibility of Linking Universal Well-Child Healthcare and Financial Counselling: Findings From the Australian Healthier Wealthier Families (HWF) Pilot Randomised Controlled Trial

Poster Number: 431
Publication Number: 431.219

Anna Price, Centre for Community Child Health, Parkville, Victoria, Australia; Natalie Schreurs, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia; Diana Contreras-Suarez, University of Melbourne, Melbourne, Victoria, Australia; Si Wang, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia; Melissa Stone, Uniting VIC TAS, Epping, Victoria, Australia; Jane Caldwell, City of Wodonga Enhanced Maternal Child Health Service, Wodonga, Victoria, Australia; Sumayya Chota, Wesley Mission Organisation, Casula, New South Wales, Australia; Amy Watts, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Nora Samir, University of New South Wales, Matraville, New South Wales, Australia; Rebekah Grace, Western Sydney University, Castle Hill, New South Wales, Australia; Shanti Raman, South Western Sydney Local Health District, Liverpool, New South Wales, Australia; Valsamma Eapen, University of New South Wales, Liverpool, New South Wales, Australia; Susan Woolfenden, University of New South Wales/USYD, Sydney, New South Wales, Australia; Sharon Goldfeld, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia

Background: “Healthier Wealthier Families” (HWF) seeks to reduce financial hardship in the early years by developing a systematic referral pathway between Australia’s universal child and family health (CFH) nursing services and financial counselling. It adapts a successful Scottish poverty reduction initiative.

Objective: This pilot study aimed to investigate the feasibility and short-term impacts of the HWF model when adapted to the Australian service context.

Design/Methods: Setting: CFH services in five sites across two states (Victoria, New South Wales), coinciding with the COVID-19 pandemic. Participants: Caregivers of children aged 0-5 years. Eligible clients disclosed one or more risk factor for financial hardship (study-designed screening tool). Design: Pilot randomised controlled trial (RCT, ACTRN12620000154909). With mixed progress in Sites 1-3 (February 2020 to November 2021), our implementation evaluation led to a simplified RCT protocol in Site 4 and a direct referral model (no randomisation, pre-post evaluation) in Site 5 (June 2021 to May 2022). Intervention: Financial counselling. The comparator in Sites 1-4 was usual care. Measures: Feasibility was assessed via proportions of clients screened, enrolled, followed-up, and who accessed financial counselling. Impacts (quantitative surveys, qualitative interviews) included finances and wellbeing to 6 months post-enrolment.

Results: 72%-100% of clients across sites answered the financial hardship screen. In RCT sites (1-4), less than one quarter enrolled. In Site 5, n=64/66 (93%) clients were eligible and interested; 44/64 (64%) engaged with financial counselling. Common challenges facing clients were utility debts (73%), obtaining government entitlements (43%) and material aid or emergency relief (27%). When financial gains from financial counselling were averaged across the 44 clients, household income from government entitlements increased $6,504 annually ($125 p/week). Families also received an average payment of $784 (from concessions, grants, brokerage, debt waivers). Caregivers identified benefits including reduced stress, practical help, increased knowledge, and empowerment.

Conclusion(s): Financial hardship screening via CFH, and direct referral, were acceptable to caregivers. Individual randomisation was infeasible. Matching populations and CFH practice must occur to feasibly incorporate a HWF model of care. This pilot is informing a state-wide evaluation of HWF with government, NGO, and philanthropy partners.

We note that J Burley, A Zhu, K Trotter, M Mrad, R Bishop, L Bui, D Sanger, R Roles, L Kemp, and R Lingam also co-authored this research.