Assistant Professor Department if Family Medicine, Queen’s University Kingston, Ontario, Canada
Background: Family poverty is associated with poor health outcomes in parents and children and remains prevalent in Canada. Healthcare providers are encouraged to screen for poverty but evidence on the effectiveness of social interventions and the role of health professionals are limited. Community Support Workers (CSWs) have a thorough understanding of potential income supports and community support agencies. Objective: To evaluate feasibility and potential effectiveness of financial support navigation with a trained CSW for families of young children in primary care to reduce parenting stress and improve child social-emotional development. Design/Methods: A prospective two-arm pilot randomized controlled trial. Families of children aged 2-5 years were eligible if they endorsed the screening question “Do you ever have difficulty making ends meet at the end of the month?” Families were randomized to the CSW intervention or usual care. The intervention was a structured review of families’ financially related needs and resources with a trained CSW, and support to identify and meet their goals. All families received a written summary of available resources. Feasibility outcomes were rates of recruitment and questionnaire completion; preliminary effectiveness outcomes were child social-emotional development, using the Strengths and Difficulties Questionnaire (SDQ) and parenting stress, using the Parenting Stress Index (PSI). Results: A total of 37 caregiver-child dyads were recruited and randomized to the CSW intervention (n=17) or usual care (n=20). Data collection yielded a 78% (n=29) questionnaire completion rate at 6 months and 59% (n=22) at 12 months. Using ANCOVA, the mean between-group difference in SDQ Total Difficulties Score (TDS) at 6 months was -1.21 (95% CI: -3.82, 1.40; p=0.35), at 12 months was 1.10 (95% CI: -3.13, 5.34; p=0.59) and PSI Total Score at 6 months was -12.88 (95% CI: -21.63, -4.12; p=0.006) and at 12 months was 7.79 (95% CI: -4.42, 20.00; p=0.20), after adjusting for baseline score. Using linear mixed effects models, the mean between-group differences in SDQ TDS at 6 months was -1.09 (95% CI: -3.81, 1.63), at 12 months was 1.08 (95% CI: -2.87, 5.04) and PSI Total Score at 6 months was -10.73 (95% CI: -19.83, -1.64) and at 12 months was 8.41 (95% CI: -2.98, 19.79), after adjusting for baseline score, child age, and sex.
Conclusion(s): Recruitment of families living in poverty and data collection were feasible. Families receiving CSW support experienced reduced parenting stress at 6 months compared to those receiving usual care but there was no difference in child social-emotional development.
