PROJECT SUMMARY & ABSTRACT
Socioeconomic status is a dominant determinant of child development and parent health. Children living
in poverty are more likely to be born preterm, be chronically ill, experience developmental delay, have cognitive
impairment, and have unmet medical needs, all with fewer resources to overcome these challenges.1-3 Parents
living in poverty are more likely to have worse overall health, mentally and physically.4 Financial stress is even
more widespread than poverty, given that half of Americans are just scraping by financially and lack savings to
cover three months of expenses,5 with consequences for child development, adult health, and health care.
Financial stress is a root cause of many social determinants of health and common social needs, such
as food and housing insecurity, that threaten health. Accordingly, pediatric professional organizations
recommend lifting children out of poverty,6 and health systems increasingly address poverty-related social
needs in clinical settings where they interfere with health and care.7 Financial services interventions could
reduce financial stress directly as a root cause of poverty-related health and developmental hazards.
Financial coaching is proven to reduce financial stress using motivational interviewing techniques and
standard tools that have been shown to improve savings, reduce debt, and build financial resilience.8 From
2015 to 2017, Dr. Schickedanz and his nonprofit community partner financial coaching organization, LIFT,
completed a pilot randomized trial showing that a community-based financial coaching intervention improved
health-related quality of life and financial stress among low-income parents receiving services at LIFT offices.
Yet community-based financial coaching is underutilized relative to the population in need and could benefit far
more low-income families if deployed in clinic-based settings families already visit regularly.
Co-locating and coordinating financial services within health systems, termed medical-financial
partnerships (MFPs), could address financial, physical, and mental health in concert and impact child
development. The effects of embedded financial services in clinical settings have yet to be explored.
My mentors, collaborators, and I will 1) study experimental outcomes of a financial coaching intervention
plus social needs navigation versus navigation alone on parent health (including mental health), child
developmental risk, and social needs in a clinical randomized controlled trial; 2) examine intervention
mechanisms of action through qualitative (focus group) and quantitative (mediation and moderation) analyses
of relationships between financial stress, social needs, parent self-efficacy, and study outcomes; and 3)
assess intervention implementation in a large public pediatric primary care clinic in Los Angeles County.
My learning goals in implementation science, qualitative methods, management of research teams and
networks will propel these aims, future trials, and my career advancing social determinants of health
interventions and understanding the mechanistic links between financial stress and health.
