Household income is a social determinant of children’s health and development. In Australia, one in three families are unable to afford material basics, and the prevalence of poor mental health triples for these caregivers. Healthier Wealthier Families (HWF) connects well-child healthcare with community-based financial counselling to provide an early intervention for financial hardship. Adapted from a Scottish model and piloted in the Australian states of Victoria and New South Wales in 2020-22, this protocol describes an evaluation of the HWF model embedded in well-child home visits in the state of Queensland. Aims are to evaluate (1) HWF effectiveness in reducing financial hardship and improving caregiver mental health, (2) cost-benefits of HWF, and (3) implementation factors necessary for broader scale-up. This study is a pragmatic, cluster randomised controlled trial (RCT) involving 336 clients receiving well-child home visiting services across all active service regions in Queensland. 24 service areas (clusters) are allocated to either immediate (‘now’) or delayed (‘next’, after 12 months) screening for financial hardship by health home visitors. Caregivers who report financial hardship and consent to referral will be contacted by a financial counsellor. Aim 1 will compare the financial hardship and mental health outcomes between the randomised groups at 13–24 months. Using these outcome data and routine financial counselling data, Aim 2 will assess the costs of the program (measured through partner reports of time and materials used in provision of the intervention) against change in outcomes in the form of a cost-consequences analysis from a government perspective. For Aim 3, qualitative interviews with caregivers and service providers will explore experiences, barriers, and enablers of implementation. Ethical approval has been granted by the Western Sydney University (#H13834) and UnitingCare Queensland (#202504) Human Research Ethics Committees. Results will be disseminated to partners and policymakers, through meetings, reports, and through peer-reviewed publications and conference presentations. Findings will inform if and how financial counselling can be embedded and scaled within universal well-child healthcare services state-wide and nationally. The trial is registered on the Australian New Zealand Clinical Trials Registry (ACTRN12625001337460).
Price et al. (Tue,) studied this question.