TARGETING CHILD MENTAL HEALTH AND HOUSEHOLD POVERTY: Impact of a Poverty Intervention in Primary Care on Preschool Children’s Emotional and Behavioural Health
Innovative Approaches to Care Delivery, Public Health, and Equity, Diversity & Inclusion
Division of Pediatric Medicine, Hospital for Sick Children, Toronto, ON
Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto
Material hardship has profound negative impacts on parents’ and children’s health. Primary care providers are called upon to address poverty but there is a lack of evidence for effective interventions. Our pilot randomized controlled trial examine the effectiveness of an intervention using structured review and system navigation with a trained community support worker who helped participants access financially related resources for which they were eligible. We enrolled 37 parent-child dyads who endorsed the screening question ‘Do you ever have difficulty making ends meet at the end of the month?’. We found no between group differences in the Strengths and Difficulties Questionnaire, but found significant improvement in parenting stress at 6 months (but not at 12 months). These results support completion of a full trial.
Background: Material hardship has profound negative impacts on the health of parents and children. Primary care providers are called upon to address poverty, but evidence for effective interventions is lacking.
Methods: We conducted a pilot pragmatic randomized controlled trial. Participants were parent-child dyads endorsing the question “Do you ever have difficulty making ends meet at the end of the month?”. The intervention was a structured review and system navigation with a trained Community Support Worker (CSW), who has a thorough understanding of potential income supports and community resources. All participants received a written summary of available resources.
Results: 37 parent-child dyads were enrolled and outcomes assessed on 29 participants at 6 months and 22 participants at 12 months. The mean between group difference in the baseline adjusted Strengths and Difficulties Questionnaire (SDQ) Total Difficulties Score at 6 months was -1.21 (95% confidence interval [CI] -3.82, 1.40, p=0.35) and at 12 months was 1.10 (95% CI -3.13, 5.34, p=0.59) and in the baseline adjusted Parenting Stress Index (PSI) 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).
Conclusion: Implementation of CSW support resulted in reduced parenting stress at 6 months. This pilot study did not find an effect on child social-emotional development. These promising results suggest that a full trial is justified.
1 manuscript is under review and another is being prepared.