Speakers
Description
Authors: Georgina Warner (Uppsala University, Sweden), Amy Bond (University of Exeter, UK), Vashti Berry (University of Exeter, UK), Eleanor Bryant (University of Exeter, UK), Nick Axford (University of Plymouth, UK), Nina Johansson (Uppsala University), Claire Cameron (University College London, UK), Mary-Alice Doyle (Nesta, UK), Georgia Smith (University of Exeter, UK), Kath Wilkinson (University of Exeter, UK), Rebecca Summers (University of Exeter, UK), Morwenna Rogers (University of Exeter, UK), James Hall (University of Southampton, UK), Iain Lang (University of Exeter, UK), Kristin Liabo (University of Exeter, UK), Ida Hedkvist (Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden), David Isaksson (Health Services Research, Department of Public Health and Caring Sciences, Uppsala University, Sweden), Anna Sarkadi (Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden), Angela Bartley (East London Foundation Trust, UK), Elizabeth Cecil (Thomas Coram Research Unit, University of College London, UK), Laura Austin Croft (East London Foundation Trust, UK), Catherine Harris (Thomas Coram Research Unit, University College London, UK), Siew Fung Lee (Thomas Coram Research Unit, University College London, UK), Matthew Oultram (East London Foundation Trust, UK), Michelle Heys (Thomas Coram Research Unit, University College London, UK), Abigail Knight (Camden Council, London, UK), Ghazal Moenie (Nesta, UK), Jun Nakagawa (Candeb Council, London, UK), Dea Nielsen (Nesta, UK), Moria Sloan (Nesta, UK and Cabinet Office, UK), Benny Souto (Camden Council, London, UK), Carla Stanke (Camden Council, London, UK), Zoe Tyndall (Camden Council, London, UK)
Chair: Georgina Warner
Background: Children who experience economic disadvantage have an increased risk of poor health, social and educational outcomes. A range of interventions across the prevention continuum exist to prevent or address poor child and youth psychosocial outcomes. Often, however, they focus on issues such as parent-child relationships, parenting skills and family functioning, paying less attention to issues such as families’ low income, debt or other financial stressors. While such issues demand a policy response, there is also scope for frontline services to support families financially and materially to improve child outcomes. This might include the direct provision of money and goods but also advice or support with income maximisation, debt reduction, money management and income generation.
Aims: This symposium explores evidence on the potential for financial well-being support (FWbS) delivered by frontline services to improve family financial well-being and thereby improve child outcomes. It focuses on the provision of such support in the context of social and health services and lessons about its nature, acceptability, implementation and impact.
Overview of presentations: Paper 1 (Bond) draws on survey and interview data from family support service managers and commissioners in England to identify models of integrated financial well-being support in family support provision. Paper 2 (Bryant) presents findings from a scoping review of the international literature on programmes that integrate parenting support and FWbS. Paper 3 (Johansson) draws on qualitative data to explore how prevention is conceptualised within Swedish Budget and Debt Counselling, with a focus on how counsellor perceptions align with formal service guidance. Paper 4 (Cameron) presents findings from a study on the feasibility and acceptability of integrating routine health appointments with welfare benefits advice in inner-city east London. Paper 5 (Doyle) outlines an ongoing pilot programme that provides low-income families in pregnancy with a cash grant alongside one-on-one advice on services and benefits.
Connection to symposium theme: The economic determinants of poor child and youth outcomes are present at all levels of the prevention continuum. Low income and related financial stressors are particularly elevated among families targeted for selective, indicated or treatment interventions, yet such interventions tend to treat them as context rather than intervention focus. FWbS can take multiple forms, with different forms and levels of intensity potentially relevant at different levels of the prevention continuum.
ABSTRACT 1
Seven models of integrated financial wellbeing support in family support services in England
Amy Bond (University of Exeter, UK), Eleanor Bryant (University of Exeter, UK), Georgia Smith (University of Exeter, UK), Kath Wilkinson (University of Exeter, UK), Nick Axford (University of Plymouth, UK), Rebecca Summers (University of Exeter, UK), Morwenna Rogers (University of Exeter, UK), James Hall (University of Southampton, UK), Iain Lang (University of Exeter, UK), Kristin Liabo (University of Exeter, UK), Vashti Berry (University of Exeter, UK)
Background: Integrating family support services is a potentially powerful tool for addressing child health inequalities. In England, Government funded Family Hubs (FH) deliver integrated early intervention support for families. These family support services offer a range of services, with a core component of the service specification being the integration of FWbS. Improving families’ financial circumstances can positively impact multiple child outcomes; however, there is limited understanding of how FWbS is best integrated into service delivery. In this study, we explored different models of integrated FWbS across England and their variations.
Methods: A mixed-methods research design was used, including a national survey of FH Managers and Commissioners (n=55) and in-depth interviews with a subset of participants (n=23). The survey and interviews aimed to understand (1) the varied models FHs use to provide FWbS to families, (2) how families reach/access this support, and (3) if/how such support is integrated with parenting support. Patient and public involvement and engagement (PPIE) sessions with parents shaped interpretation of the findings.
Results: Findings provide a national overview of the integrated FWbS delivered in FHs in England. Seven models of integration were identified: (1) signposting, (2) referrals, (3) outreach sessions, (4) co-location, (5) practitioner-led support, (6) integration within parenting programmes, and (7) multi-level integration. Each model’s structure, prevalence and delivery partnerships as well as whether FWbS was provided at a preventive level or as part of early intervention services were explored.
Discussion: These findings enhance understanding of integrated FWbS models and will inform future development and evaluation of FWbS within family support services.
ABSTRACT 2
Integrated parenting and financial wellbeing support programmes: a scoping review
Eleanor Bryant (University of Exeter, UK), Morwenna Rogers (University of Exeter, UK), Amy Bond (University of Exeter, UK), Georgia Smith (University of Exeter, UK), Rebecca Summers (University of Exeter, UK), James Hall (University of Southampton, UK), Kristin Liabo (University of Exeter, UK), Iain Lang (University of Exeter, UK), Vashti Berry (University of Exeter, UK), Nick Axford (University of Plymouth, UK)
Background: Childhood experiences of economic disadvantage have harmful and long-lasting effects. Universal prevention and early intervention can reduce some of these harms, but it is unclear whether addressing economic disadvantage alongside psychosocial support yields additional benefits. The objectives of this study were to describe programmes that integrate parenting support (PS) and financial wellbeing support (FWbS), document relevant components and evaluation designs, and consider if any programmes merit replication and testing in the UK.
Methods: We conducted a scoping review to identify evaluated programmes that integrate PS and FWbS for parents of children aged 0-19 years. Outcome or implementation evaluations of integrated PS and FWbS programmes published in English in peer-reviewed or grey literature were included (no publication date or geographical limitations). A database search was supplemented by a programme registry search and consultation with parenting experts. Data were extracted for: publication and study characteristics; programme description; evaluation method; and measures used.
Results: Searches yielded 2988 (databases) and 346 (registries) articles and 20 programmes (expert consultation). We discuss the 10 articles covering 10 programmes that were included. We describe the characteristics of programmes, such as the principal provision of PS with minimal FWbS (mostly money management). All programmes were targeted rather than universal. Most studies measured financial, parent health/well-being, parenting or child health/development outcomes, but it was uncommon to measure all four. Few studies measured implementation outcomes. Only a small number of programmes integrate PS and FWbS, and they are heterogeneous in design, content and evaluation.
Discussion: Integrated PSFWbS programmes are uncommon. In the programmes we identified, FWbS content (mostly money management) was minimal compared with PS. The programmes were also evaluated inconsistently, with scant attention to mechanisms. Elements of the programmes could be adopted and adapted in integrated PSFWbS interventions. Mixed-methods evaluations are needed to explore effectiveness and impact mechanisms.
ABSTRACT 3
"The key issue is the definition of preventive counselling" – a multi-method study exploring the prevention continuum within Swedish Budget and Debt Counselling
Nina Johansson (Uppsala University), Ida Hedkvist (Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden), David Isaksson (Health Services Research, Department of Public Health and Caring Sciences, Uppsala University, Sweden), Anna Sarkadi (Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden),Georgina Warner (Uppsala University, Sweden)
Background: Prevention is a central but often ambiguously defined concept within public support services. In Swedish Budget and Debt Counselling (BDC), counsellors have been encouraged to adopt more preventive approaches, yet the meaning of preventive counselling remains unclear. This presentation explores how prevention is conceptualised within BDC, with a focus on how counsellor perceptions align with formal service guidance.
Methods: This convergent, qualitative multi-method study used content analysis to examine two sources: survey responses from BDC counsellors and guidance documents from national and local authorities. The deductive analysis explored how counsellors’ responses and guidance document content aligned with the continuum of prevention, ranging from primary to secondary and tertiary approaches.
Results: With regard to primary prevention strategies, both counsellors and guidance documents cited service visibility as a motive for outreach and lectures as a preferred format for providing financial education. Collaboration was highlighted as a necessity to reach ‘at-risk’ groups within secondary prevention, and debt restructuring was a prominent focus within tertiary prevention. Yet, the emphasis given to each prevention level differed. Counsellors more often referred to primary and secondary prevention strategies, calling for more resources to enact such practices. In contrast, guidance documents were largely focused on tertiary prevention, with primary and secondary prevention absent from some documents, reflecting the service’s legal mandate to support individuals already in financial crisis.
Discussion: The findings highlight the need for clearer, more actionable guidance on primary and secondary prevention within BDC services. Greater alignment between policy and practice, supported by resources and training, could enhance the service’s preventive capacity. More broadly, the study illustrates the value of articulating prevention concepts in practice settings and equipping professionals with the tools to translate policy into meaningful action.
ABSTRACT 4
Ameliorating the impact of child poverty by integrating health appointments with welfare benefits advice in East London
Claire Cameron (University College London, UK), Angela Bartley (East London Foundation Trust, UK), Elizabeth Cecil (Thomas Coram Research Unit, University of College London, UK), Laura Austin Croft (East London Foundation Trust, UK), Catherine Harris (Thomas Coram Research Unit, University College London, UK), Siew Fung Lee (Thomas Coram Research Unit, University College London, UK), Matthew Oultram (East London Foundation Trust, UK), Michelle Heys (Thomas Coram Research Unit, University College London, UK)
Background: While 4.5 million children are growing up in poverty in the UK, £23bn in welfare benefits and social tariffs goes unclaimed each year. To ameliorate the impact of child poverty by improving access to welfare benefits advice (WBA), this study aimed to evaluate the feasibility and acceptability of integrating routine health appointments with WBA in inner-city east London, where over half of children are impoverished and there is a high prevalence of risk factors for poverty: children with a disability, larger families, and among Black and Asian families. We aimed to elucidate the factors that make co-located WBA more or less acceptable and feasible.
Methods: Using a mixed-methods approach, the study analysed financial impact data from 174 referrals at one site and conducted interviews with 55 parents and 12 professionals across three sites. The sites were a children’s neurodisability clinic, a children’s centre and a community health centre. In each case families with money worries were referred to an onsite welfare benefits advisor. Analysis was carried out via thematic mapping and coding.
Results: Co-locating health and WBA was acceptable and resulted in substantial financial gains for parents. Three key themes: (i) enhanced service accessibility by leveraging existing trust in healthcare institutions; (ii) language barriers and digital exclusion presented significant challenges; and (iii) substantial financial impact, enhancing agency and wellbeing. At one site, 60 families gained an average of £6,898 annually in additional income and support.
Discussion: Co-locating WBA services within health and community settings is both feasible and acceptable. Success factors included flexible delivery, streamlined referral processes, and culturally sensitive approaches. However, implementation requires careful attention to language support and privacy concerns within close-knit communities. While promising, co-located WBA does not fully prevent poverty arising or overcome systemic inadequacies in the welfare state. We are now carrying out a trial of WBA integrated with health visiting enrolment for new parents attending children and family centres.
ABSTRACT 5
Stacking prenatal interventions: real-world challenges and solutions
Mary-Alice Doyle (Nesta, UK), Abigail Knight (Camden Council, London, UK), Ghazal Moenie (Nesta, UK), Jun Nakagawa (Candeb Council, London, UK), Dea Nielsen (Nesta, UK), Moria Sloan (Nesta, UK and Cabinet Office, UK), Benny Souto (Camden Council, London, UK), Carla Stanke (Camden Council, London, UK), Zoe Tyndall (Camden Council, London, UK)
Background: The academic evidence tells us that financial support – particularly if it is provided to low-income families in pregnancy – can help to prevent a range of adverse health and developmental outcomes for the baby. Recently, researchers have proposed that there may be greater gains from ‘stacking’ financial support alongside other services; the impacts of a ‘stacked’ intervention may be greater than the sum of its parts. However, there are practical and administrative challenges in providing such support in pregnancy, meaning that the evidence base on prenatal stacked interventions is small.
Methods: We outline an ongoing pilot program that provides two ‘stacked’ offers to low-income families in pregnancy: a cash grant, alongside the offer of personal one-on-one advice from a ‘Family Navigator’ to help parents find and sign up to services and benefits available to them. We present a Toolkit setting out the practical and administrative steps needed to replicate such an intervention elsewhere. A mixed-methods evaluation of the pilot is ongoing and results are not yet available. This includes randomisation of the Family Navigator offer and analysis of its impact on service use through to the baby's first birthday. Alongside the RCT, we are conducting surveys, interviews, and analysis of process data, as part of a theory-based evaluation of the value-add of the stacked intervention.
Results: Our Toolkit aims to equip researchers, local government service providers and voluntary organisations with practical resources to help them set up and evaluate similar ‘stacked’ interventions, targeted at low-income families during pregnancy.
Discussion: We have good reason to think that well-designed ‘stacked’ interventions delivered in pregnancy can help to prevent adverse health and developmental outcomes, though there is little empirical evidence on this. In order to test these theories and build the evidence base, we must overcome practical challenges in implementing such programs. The goal of our Toolkit is to enable more researchers and local service providers to work together to test such interventions and generate evidence. In doing so, we will learn more about which types of stacked interventions work, and what are the barriers and enablers to success.
| Conflict of interest | The authors declare that they have no conflicts of interest. |
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