P3.D065: Evaluating the Impact of Clinic-Based Financial Coaching on Pediatric Preventive Healthcare

Background: Poverty is a social determinant of health that has profound impacts on children’s healthcare and quality of life, influencing development, mental health, and physical well-being with disproportionate impact on communities that experience economic marginalization based on race. While current literature reveals the positive impacts of clinic-based financial coaching on financial well-being, evidence on child healthcare outcomes is limited. The aim of this study is to assess the impact of clinic-based financial coaching on recommended well child check (WCC) adherence from infancy to the third year of life.

Methods: Low-income parent-infant dyads receiving care from a large, academically-affiliated, safety-net hospital-based primary care pediatrics clinic were enrolled in two cohorts – one in a randomized trial and another in a subsequent non-randomized cohort - from 2018 to 2023. Dyads with an infant less than 2 months were eligible for enrollment in both cohorts and received either usual care (control) or pediatric clinic-based financial resilience coaching. The coaching intervention was provided by coaches trained in social work, with a focus on longitudinal parent-identified financial goals, social needs support, and care coordination. Counts of total number of well child visits attended were analyzed at three main intervals post-enrollment: to 12 months (through 9-month WCC), 24 months (through 18-month WCC), and 36 months (through 30-month WCC). Patients less than 12 months, 24 months, and 36 months of age were excluded from the respective analyses. Demographics were obtained from parent-reported surveys and primary care periodicity schedule visit data were collected via electronic medical record. Descriptive statistics and two sample t-tests were calculated in Stata (version 18.0).

Results: 455 parent-infant dyads were included in our analysis - 179 controls and 276 in the intervention, with similar demographic characteristics between the groups. Adherence to recommended preventive care pediatric visits was higher in the intervention group compared to controls by 12 months (3.58 vs 3.89 total periodicity schedule visits attended, p=0.042), 24 months (5.14 vs 5.65 visits attended, p=0.064), and 36 months (5.68 vs 6.52 visits attended, p=0.035) post-enrollment.

Conclusion: In our randomized trial, families who received clinic-based financial resilience coaching beginning while their children were infants attended more well child visits through the first three years of child age. This suggests financial resilience coaching increases adherence to recommended preventive visits, improving quality of care.