"It Turned Our Life Around for the Better": An Implementation Assessment of a Financial Resilience Coaching Intervention for Low-Income Parents

Background: Poverty-related stress in childhood adversely impacts health outcomes throughout the life course. To address poverty-related health risks and promote financial well-being, the UCLA Medical-Financial Partnership (MFP) program offers a financial resilience coaching intervention to low-income parents at three Los Angeles County Department of Health Services safety-net clinics (pediatrics, prenatal, family medicine). Financial resilience coaches utilize an individually tailored, family-centered approach to support parents toward financial-, social-, and health-related goals through resource navigation, care coordination, and parent-coach collaboration. Coaching is offered in clinic visits and virtually through phone, text, and email. We aimed to evaluate the MFP’s clinically-integrated financial resilience coaching intervention implementation by exploring experiences of parent participants.

Methods: Five semi-structured focus groups and 13 semi-structured interviews were conducted with 24 current or former MFP coaching participants. Participants were recruited via phone or text and interviewed between November 2022 and June 2023. Participants were predominantly female (92%; 8% male), English-speaking (71%; 29% Spanish-speaking), Hispanic/Latino/a (58%; 17% Asian; 8% Black/African American; 8% White; 8% Other), connected to the program through the Pediatrics clinic (67%; 21% Family Medicine; 13% Prenatal), and had at least one child ages 3 or younger (83% with child ≤ 3 years; 17% with child ≥ 4 years). Pre-interview questionnaires collected demographic, satisfaction, and goal attainment information. The interview guide included open-ended questions on perception of finances and social needs, identification and attainment of goals, participants’ program experience, and participants’ program recommendations. Focus group and interview transcripts were thematically analyzed using an interpretive phenomenological approach in Dedoose qualitative research software.

Findings: All participants reported they would recommend the program to a friend or family member on the pre-interview survey. Participant-identified program success facilitators included positive communication (reported by 96%), resources provided (88%), program accessibility (83%), and coach knowledge (71%). Reported program benefits included social needs-related goal attainment (71%), increased parent education and access (58%), and parent empowerment (54%). Nearly all participants (92%) reported that the program positively influenced continuing care at their clinic. Alongside these benefits of clinical financial resilience coaching, parent-reported challenges included competing stressors and structural barriers that could impact their ability to participate. Participants also recommended expanding the program, implementing parent groups, and improving program visibility and knowledge. Parent participants expressed gratitude and satisfaction with the program, with one parent describing its impact as follows: “I’m actually very, very thankful that we said yes...that first day, because that definitely changed our life. It turned our life around for the better.”

Conclusions and Implications: Findings from this implementation assessment suggest that healthcare-integrated interventions addressing poverty-related social needs and promoting financial well-being are accepted by and impactful for low-income parents. Participants reported several benefits of the program and expressed high rates of satisfaction. This highlights the importance of implementing family-centered approaches in healthcare and other settings to improve health outcomes for children and families.