Embedding financial services in trusted settings addresses poverty and improves health equity

New research from Boston Medical Center (BMC) shows that parents desire easy access to financial services in places they trust that build upon their own efforts to create a better economic future for themselves and their children. Medical settings can meet these needs by embedding financial services within clinics and community settings to help create economic mobility, like BMC's StreetCred program. Published in the Journal of Developmental and Behavioral Pediatrics, the study highlights approaches to instill and strengthen trust between families and institutions like schools, health care systems, and financial services. This trust-building is particularly important to improve access in communities of color, where institutional distrust and health inequity are critical concerns.

By capitalizing on their position as anchor institutions to create sustainable and equitable economies that support the long-term health of their surrounding communities, leading healthcare systems, like BMC, are offering financial services to patient families and are calling on others to do the same. In this effort, pediatric clinics are ideally positioned to directly intervene on child poverty to improve health and development across the child's life.

"Our findings underscore how imperative it is for medical-financial partnerships to validate low-income parents' in-depth knowledge of poverty, their progress toward economic mobility, and their prior experiences with financial services," says Savannah Alexander, MPH, a former research assistant at BMC and graduate of the Boston University School of Public Health. "We hope that medical-financial partnerships will apply this empathetic, strengths-based approach as they embed financial services, working to build trust with families, empower them to emerge from poverty, and reduce racial and socioeconomic inequities in child health and development in the long term."

In this study, StreetCred offered free tax preparation to parents at Epiphany School, an urban community school for low-income families. Parents were interviewed prior to and after filing their 2019 taxes (about half chose to file using the StreetCred tax service) for information about how they saw financial strain impacting their family's future, their efforts to create economic mobility, and their experiences with and perceptions of the StreetCred tax service and other financial services.

Almost all the parents identified as being of color, primarily Black or African American, and were able to give important insights into factors that contribute to racial and socioeconomic inequities in child health and development, including racial stigmatization by financial service personnel. At least half of the participants were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP), and utilized subsidized or public housing.

"Participants endorsed the StreetCred tax service as a much-needed, empowering, trustworthy, and accessible alternative to the for-profit tax preparation industry," says Lucy Marcil, MD, MPH, executive director of StreetCred, a pediatrician at BMC and an assistant professor of pediatrics at Boston University School of Medicine. "Providing a bundled, bi-generational approach supports families' ability to build long-term economic mobility more than providing tax preparation services alone."

Researchers developed the following grounded theory model based on their five key thematic findings to describe the acceptability and use of financial services within the context of parents' lived experiences and pre-existing efforts to build economic mobility:

(1) Families experience multilevel barriers to economic mobility. Despite these barriers, parents are already proactively working to build economic mobility by (2) empowering the next generation with knowledge, skills, and assets and (3) resiliently pursuing economic goals. As a result, (4) parents will accept empowering, nonjudgmental, expert, and trustworthy financial services that contribute to their existing efforts. To move from acceptance to use, (5) financial services must be effectively publicized, accessible, and supportive.

The findings of this study align with previous literature that found poverty is associated with additional social and mental health stressors that negatively affect parenting and maternal-child health. To that point, embedded financial services need to offer parents consistent and holistic support to facilitate the management of financial services and sustain engagement.