Effectiveness & Implementation of Medical-Financial Partnerships for Parent Health-Related Quality of Life and Child Developmental Risk

项目总结与摘要 社会经济地位是儿童发展和父母健康的主要决定因素。活着的孩子 贫困的人更有可能早产，患有慢性病，经历发育迟缓，有认知 残疾，以及未得到满足的医疗需求，所有这些都只有较少的资源来克服这些挑战1-3名父母 生活在贫困中的人在心理和身体上的整体健康状况更有可能变差。 比贫穷更普遍，因为一半的美国人经济上勉强度日，没有储蓄来 支付3个月的费用，5个月，包括对儿童发育、成人健康和医疗保健的影响。 经济压力是健康和共同社会需求的许多社会决定因素的根本原因，例如 由于粮食和住房不安全，这威胁到健康。因此，儿科专业组织 建议让儿童脱贫，6卫生系统越来越多地解决与贫困有关的社会问题 干扰健康和护理的临床环境中的需求。7金融服务干预可以 减少财政压力，将其作为与贫困相关的健康和发展危害的根本原因。 事实证明，财务指导可以使用激励性面试技巧和 已被证明可提高储蓄、减少债务和建立财务弹性的标准工具。8 2015年至2017年，Schickedanz博士和他的非营利性社区合作伙伴金融教练组织Lift， 完成了一项试点随机试验，显示以社区为基础的财务指导干预有所改善 接受电梯办公室服务的低收入父母的健康相关生活质量和经济压力。 然而，与有需要的人群相比，以社区为基础的金融培训没有得到充分利用，可能会受益很多。 如果部署在以诊所为基础的环境中，更多的低收入家庭已经定期就诊。 共同定位和协调卫生系统内的金融服务，称为医疗-财务 伙伴关系(MFP)，可协调解决经济、身体和心理健康问题，并影响儿童 发展。嵌入式金融服务在临床环境中的影响还有待探索。 我的导师、合作者和我将1)研究金融指导干预的实验结果 在父母健康(包括心理健康)、儿童健康方面，社交需求导航与单独导航相比 一项临床随机对照试验中的发育风险和社会需求；2)检查干预措施 通过定性(焦点小组)和定量(调解和缓和)分析的行动机制 经济压力、社会需要、父母自我效能感与学习成绩的关系； 评估洛杉矶县一家大型公立儿科初级保健诊所的干预实施情况。 我的学习目标是实施科学、定性方法、研究团队管理和 网络将推动这些目标、未来的试验和我的职业生涯，推动健康的社会决定因素 干预和理解财务压力和健康之间的机械联系。

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.