In an article being early released in Pediatrics, Dr. Lucy Marcil, leading a team based at Boston Medical Center, described a unique advocacy program that is nested within pediatric primary care and designed to support the financial needs of pediatric patients and their families (10.1542/peds.2023-065286). Economic resources have been well shown to aid in achieving good health and well-being, so their work focused enrolling families during an infant’s first year of life to receive economic resources intended to reduce the impact of poverty on health and well-being.
The team created an “economic bundle” for the population served in their primary care clinic, of whom 85% were Medicaid insured, 68% were either Black/African American or Hispanic/LatinX, 35% experienced housing instability or homelessness, and 30% were immigrants (with just half speaking English), characteristics that increase risk for financial instability and barriers to resource access.
The “bundle” was delivered by StreetCred Financial Navigators, not pediatricians, at well-care visit touchpoints before or after medical care and virtually between visits, and includes the following (thanks to the StreetCred webpage for the hyperlinks):
- WIC—the US Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants and Children
- SNAP—the US Department of Agriculture’s Supplemental Nutrition Assistance Program
- BMC’s Preventive Food Pantry—the food pantry at Boston Medical Center
- 529 College Savings Account (529 CSA)—a tax-free plan to facilitate college savings
- Paid Family and Medical Leave (PFML)—a state program permitting people to take paid leave from their employment for family or medical reasons
- Family Self-Sufficiency Program (FSS)—a state-based section 8/housing choice voucher program initiative designed to connect tenants with resources to achieve financial independence
Among families who received the economic bundle, what were their outcomes? Of 311 families approached at the newborn visit and engaged, 183 with infants ≥6 months old by June 2023 could be evaluated, and enrollment in resources was increased:
- WIC—58% (up from 31% at baseline)
- SNAP—41% (up from 23% at baseline)
- BMC Food Pantry—39% (up from 17% at baseline)
Please read the article and watch the engaging video summary for additional details! The authors acknowledge that the association of the StreetCred economic bundle intervention with increased uptake of financial resources may not be causal, even though that assumption appears reasonable.
Is this incredible intervention generalizable beyond Boston Medical Center? Would it be right for your clinical setting? The authors add helpful notes about feasibility and implementation that can help guide you.
An “economic bundle” of resources is a unique type of advocacy that holds great promise for low-income families. Thanks to the authors for describing their experiences.
