Strategy. Financial Coaching
Approach. Address social determinants of health, such as poverty, food insecurity, and housing instability, that can impact a child's ability to access healthcare
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Overview. Clinically embedded programs that address financial stressors may prevent missed visits and improve appointment attendance rates. Clinic-based financial coaching delivered by trained coaches addresses parent-identified, strengths-based financial goals (employment, savings, public benefits enrollment, etc.) and can also include social needs screening and resource referral. Findings show that attendance at recommended preventive care pediatric visits and vaccinations are improved as a result of financial coaching.[1]
Evidence. Moderate Evidence.
Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").
Access the peer-reviewed evidence
through the MCH Digital Library or related evidence source.
(Read more about understanding evidence ratings).
Source. Peer-Reviewed Literature
Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):
- Health Equity. This strategy helps contribute to reducing disparities or avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.
- Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.
Intervention Type. Consultation (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).
Intervention Level. Individual/Family-Focused
Examples from the Field.
There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.
Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).
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Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")
- Number of families screened for social determinants of health (SDOH) needs during healthcare encounters. (Measures identification of social needs.)
- Number of referrals made to community resources and support services to address identified SDOH needs. (Captures linkages to social interventions.)
- Number of healthcare staff trained on SDOH screening, referral processes, and trauma-informed care practices. (Assesses workforce capacity building.)
- Number of families who receive assistance with SDOH needs (e.g., food, housing, income support) through healthcare-based interventions. (Measures impact on social needs.)
- Number of children who access needed healthcare services after their families' SDOH needs are addressed. (Captures impact on foregone care reduction.)
- Number of children who experience improved health outcomes and reduced disparities through SDOH interventions. (Indicates health equity impact.)
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Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")
- Percent of healthcare encounters that include comprehensive SDOH screening and assessment. (Measures systematic integration of SDOH into care processes.)
- Percent of referrals to SDOH support services that are successfully completed and utilized by families. (Captures referral effectiveness and closed-loop processes.)
- Percent of SDOH interventions that are designed and implemented with input from families and community partners. (Assesses participatory approach.)
- Percent of families who report improved ability to access healthcare for their children after receiving SDOH support. (Measures family-reported impact on access.)
- Percent of children from low-income and historically marginalized communities who achieve equitable health outcomes through SDOH interventions. (Captures equity impact.)
- Percent reduction in child health disparities associated with SDOH factors such as poverty, food insecurity, and housing instability. (Assesses progress toward health equity.)
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Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")
- Number of cross-sector partnerships established to create coordinated systems of care that address SDOH and healthcare access. (Measures collaborative infrastructure.)
- Number of policies and funding mechanisms implemented to support the integration of SDOH interventions into healthcare delivery. (Captures enabling environment.)
- Number of innovative models and best practices for addressing SDOH tested and spread across healthcare organizations. (Assesses learning and dissemination.)
- Number of communities that demonstrate sustained reductions in child health disparities through comprehensive SDOH strategies. (Measures long-term population health impact.)
- Number of healthcare organizations that report improved performance on cost, quality, and equity measures as a result of addressing SDOH. (Captures healthcare value impact.)
- Number of multi-sector initiatives that successfully align resources and interventions to advance child health equity through SDOH approaches. (Assesses collective impact.)
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Quadrant 4:
Measuring Quality of Effect ("How are they better off?")
- Percent of SDOH interventions that prioritize and tailor strategies for children and families facing the greatest social and economic barriers. (Measures targeted universalism approach.)
- Percent of healthcare organizations that allocate resources and form partnerships to address SDOH needs in the most under-resourced communities they serve. (Assesses equity focus.)
- Percent of SDOH data collection and analysis efforts that disaggregate findings by race, ethnicity, language, and other dimensions of equity. (Captures equity data practices.)
- Percent decrease in the gap between children from socially and economically advantaged and disadvantaged families in accessing essential healthcare services. (Measures equity impact.)
- Percent of children from historically marginalized communities who receive care in welcoming, culturally responsive environments as a result of SDOH interventions. (Assesses culturally effective care.)
- Percent increase in the proportion of healthcare resources and interventions directed towards eliminating root causes of health inequities for children. (Captures health equity investments.)
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Note. When looking at your ESMs, SPMs, or other strategies:
- Move from measuring quantity to quality.
- Move from measuring effort to effect.
- Quadrant 1 strategies should be used sparingly, when no other data exists.
- The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.
Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.
References
[1] Schickedanz, A., Perales, L., Holguin, M., Rhone-Collins, M., Robinson, H., Tehrani, N., Smith, L., Chung, P. J., & Szilagyi, P. G. (2023). Clinic-Based Financial Coaching and Missed Pediatric Preventive Care: A Randomized Trial. Pediatrics, 151(3), e2021054970.
