Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study
Sharon Goldfeld,
Susan Woolfenden,
Shanti Raman,
Raghu Lingam,
Anna Zhu,
Nora Samir,
Valsamma Eapen,
Si Wang,
Amy Watts,
Lynn Kemp,
Anna M H Price,
Rebecca Bishop,
Diana Contreras-Suárez,
Jade Burley,
Rebekah Grace,
Jane Caldwell,
Sumayya Chota,
Natalie White,
Melissa Stone,
Kellie Trotter,
Mona Mrad,
Lien Bui,
Debbie Sanger,
Rob Roles
Affiliations
Sharon Goldfeld
Population Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
Susan Woolfenden
Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
Shanti Raman
Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
Raghu Lingam
BestSTART-SWS, Ingham Institute, Liverpool, New South Wales, Australia
Anna Zhu
School of Economics, Marketing and Finance, RMIT University, Melbourne, Victoria, Australia
Nora Samir
Sydney Children’s Hospitals Network Randwick, Randwick, New South Wales, Australia
Valsamma Eapen
BestSTART-SWS, Ingham Institute, Liverpool, New South Wales, Australia
Si Wang
Psychiatry and Mental Health/ School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
Amy Watts
Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Victoria, Australia
Lynn Kemp
Translational Research and Social Innovation (TReSI), Western Sydney University, Penrith South, New South Wales, Australia
Anna M H Price
Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Victoria, Australia
Rebecca Bishop
Wesley Mission, Sydney, New South Wales, Australia
Diana Contreras-Suárez
Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, Melbourne, Victoria, Australia
Jade Burley
Sydney Children’s Hospitals Network Randwick, Randwick, New South Wales, Australia
Rebekah Grace
BestSTART-SWS, Ingham Institute, Liverpool, New South Wales, Australia
Jane Caldwell
Wodonga Enhanced Maternal and Child Health Service, City of Wodonga, Wodonga, Victoria, Australia
Sumayya Chota
Wesley Mission, Fairfield, New South Wales, Australia
Natalie White
Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Victoria, Australia
Melissa Stone
Uniting Vic.Tas, Epping, Victoria, Australia
Kellie Trotter
Hume Enhanced Maternal and Child Health, Hume City Council, Hume, Victoria, Australia
Mona Mrad
Uniting Vic.Tas, Epping, Victoria, Australia
Lien Bui
Child and Family Health Services, Fairfield, New South Wales, Australia
Debbie Sanger
Child and Family Health Services, Albury, New South Wales, Australia
Rob Roles
Uniting Vic.Tas, Broadmeadows, Victoria, Australia
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.
