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In pediatric clinics and waiting rooms, anti-poverty initiatives are making a difference :

September 26, 2016

“Can you help me with my taxes?”

This question asked by a mother — and her subsequent difficulty obtaining assistance — motivated pediatric residents at Boston Medical Center (BMC) to establish StreetCred, a free tax preparation service for low-income patients’ families. During its first tax season this year, StreetCred completed approximately 200 tax returns, resulting in nearly $400,000 in refunds.


Anti-poverty community initiatives like StreetCred are one way that pediatricians are helping to improve the health of children living in poverty, which affects 16 million U.S. children. Research shows that poverty can have an adverse effect on children’s health, contributing to low birthweight, chronic illnesses, infant mortality, poor nutrition, injuries, obesity and delayed development. Addressing poverty’s impact on child health is a top AAP priority.

Michael K. Hole, M.D., one of the BMC pediatric residents who started StreetCred, initially referred the mother with the tax question to a free tax service in Boston. He learned at a later appointment that she, along with her toddler and newborn, took two buses and a train to get to the location, only to find it closed.

“That mother’s experience was proof to me that poor families are not only strapped for money but also for time, especially when they are raising children,” said Dr. Hole. “Her question inspired us to make a one-stop shop for anti-poverty tools in the pediatrician’s office.”

StreetCred was established at BMC’s pediatric clinic, where the majority of patients are on Medicaid. StreetCred volunteers completed tax forms for families, and tax experts, provided by the local Internal Revenue Service’s Volunteer Income Assistance program, reviewed the forms for accuracy.

One of StreetCred’s goals was to raise awareness about free tax preparation services and the earned income tax credit (EITC), which both benefit individuals and families in need.

‘Luxuries’ include winter coat

StreetCred’s first customer was a grandmother raising her grandson. She previously had her taxes done by a company that subtracted a percentage of her refund as payment. A part-time worker at a fast food restaurant, she was spending 5% of her annual income on filing taxes. With the help of StreetCred, she was able to keep her full tax refund, which came to $3,000 because of the EITC. She used the money to buy “luxuries” for her grandson that she could not afford before, including a winter coat, a high chair, and fresh fruits and vegetables.

“As pediatricians, our responsibility is broad in terms of what encompasses children’s health,” said Lucy Marcil, M.D., a BMC pediatric resident who started StreetCred with Dr. Hole. “It’s insufficient to simply address acute medical issues or preventive health. If we want to improve children’s health and help poor children have a better chance at life, then we have to think on a more global scale.”

Healthy partnerships


On Fridays, a mobile food pantry stops at SSM Health Cardinal Glennon Children's Hospital in St. Louis, Mo.On Fridays, a mobile food pantry stops at SSM Health Cardinal Glennon Children's Hospital in St. Louis, Mo.SSM Health Cardinal Glennon Children’s Hospital in St. Louis, Mo., also is making it easier for families to access necessities. The hospital has partnered with the St. Louis MetroMarket, which converted a city bus into a mobile farmers market that provides healthy, affordable food to residents of St. Louis food deserts. Every Friday, the bus visits the hospital.


Kenneth A. Haller Jr., M.D., FAAP, president of the AAP Missouri Chapter and associate professor of pediatrics at St. Louis University, is among those who writes prescriptions for his families, enabling them to buy food from the traveling food market at a discounted price.

Dr. Haller’s practice, Danis Pediatrics located at Cardinal Glennon Children’s Hospital, also has social workers who help low-income families find assistance programs and resources. In addition, Danis Pediatrics participates in the Reach Out and Read program and received a grant from Mind Full of Words, a program designed to improve preschool children’s vocabularies.

Dr. Haller advises pediatricians to watch for organizations or schools sponsoring programs that address the needs of children. He said they usually are receptive to working together and can make a huge difference in the lives of low-income patients and families.

Other family-centered services

Another program hoping to make a difference is the Rochester-Monroe Anti-Poverty Initiative, which aims to reduce poverty in the region by 50% over the next 15 years. Nearly half of all children in Rochester, N.Y., live in poverty, according to the U.S. Census Bureau.

Among the efforts, the initiative aims to ensure high-quality, affordable child care, as well as in-home visits to teach parents the skills they need to succeed as their children’s first teachers.

Poverty needs to be addressed both in and out of the office by focusing on community health and advocating for children on a societal level, said Jeffrey M. Kaczorowski, M.D., FAAP, who is involved in the Rochester-area efforts. In addition, he is national director of the AAP Community Pediatrics Training Initiative, which has provided grants, educational tools and training on community health and advocacy to 100 pediatric residency programs in 45 states.

“Poverty is incredibly persistent in the U.S. and affects many children,” Dr. Kaczorowski said. “Poverty’s impact on health has been well-defined. Pediatricians have to become involved, and we will be asked to do more as part of health care reform.”

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