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

项目概要和摘要 社会经济地位是儿童发展和父母健康的主要决定因素。儿童 在贫困中，更有可能早产、患慢性病、发育迟缓、认知能力低下， 残疾，医疗需求未得到满足，克服这些挑战的资源都较少。 生活在贫困中的人更有可能有更差的整体健康，精神和身体。 考虑到一半的美国人只是在经济上勉强度日，缺乏储蓄， 支付三个月的费用，5对儿童发展、成人健康和保健产生影响。 财政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， 粮食和住房不安全，威胁健康。因此，儿科专业组织 建议使儿童摆脱贫困，6卫生系统越来越多地解决与贫困有关的社会问题， 金融服务干预措施可在影响健康和护理的临床环境中发挥重要作用。 减少直接作为与贫穷有关的健康和发展危害根源的财政压力。 财务教练被证明可以减少财务压力，使用动机性面试技巧， 标准工具已被证明可以提高储蓄，减少债务，并建立财务稳健性。 2015年至2017年，Schickedanz博士和他的非营利社区合作伙伴财务教练组织LIFT， 完成了一项试点随机试验，表明以社区为基础的金融辅导干预改善了 在LIFT办事处接受服务的低收入父母与健康有关的生活质量和经济压力。 然而，相对于有需要的人口而言，基于社区的财务辅导没有得到充分利用， 更多的低收入家庭，如果部署在诊所为基础的设置家庭已经定期访问。 在卫生系统内合用同一地点和协调金融服务， 合作伙伴关系（多功能一体机），可以解决财政，身体和心理健康的协调一致，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讨。 我的导师、合作者和我将1）研究财务辅导干预的实验结果 加上社会需求导航与导航单独对父母的健康（包括心理健康），儿童 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（调解和适度）分析的行动机制 经济压力、社会需求、父母自我效能感和学习成果之间的关系; 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，研究团队的管理， 网络将推动这些目标，未来的试验，以及我的职业生涯，促进健康的社会决定因素 干预措施和理解财政压力与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.