Background: Social factors outside of medical care underlie many of the disparities in population health outcomes. In particular, economic hardship is strongly associated with other adverse social determinants of health, decreased life expectancy, and increased health risks. In the United States, 2 out of 5 children live in low income households, and children are particularly vulnerable to the “toxic stress” of financial instability. Accordingly, the American Academy of Pediatrics and American Academy of Family Physicians recommend that providers screen all patients and families for financial insecurity as part of routine health care visits.
Objective: To characterize perception of financial strain, social need, and interest in support services in an urban, safety net clinic.
Methods: Based on a literature review of existing screening tools, we constructed a financial and social needs assessment that was finalized by consensus with study colleagues and pediatric care providers. Survey domains included perception of financial strain, asset poverty, debt risk, social needs, interest in support services, and demographic data. Between June and July 2018, the survey was administered to pediatric patients and family members at the Harbor-UCLA Pediatrics Clinic in Torrance, Los Angeles.
Key Results: Of 220 participants, respondents were primarily female (88%), Hispanic (67%), and between the ages of 22 and 31 (38%). There was a high degree of variability in perceived financial strain, with Consumer Financial Protection Bureau Financial Well-Being Scale Scores ranging from 19 (greatest strain) to 82 (least strain), with an average score of 56.1 and standard deviation of 13.3. The basic living costs that participants expressed most difficulty paying for were rent/housing (72% expressed some difficulty), utility bills (63%), and transportation (57%). 76% of participants had some difficulty paying for living costs generally, and 84% expressed that they would have trouble handling an emergency expense. Perceived financial strain was positively associated with endorsed social need for all needs surveyed, with coefficients ranging from -0.057 (-0.070, -0.045) for rent/housing to -0.046 (-0.061, -0.031) for child care.
Conclusion: There is clear interest in financial and social support services amongst families at the Harbor-UCLA Pediatrics Clinic. A substantial majority of families expressed difficulty with meeting basic living expenses (especially rent/housing, utility bills, and transportation), as well as a desire for financial and social support services (especially employment, job training, and rent/housing). Screening tools that measure financial strain and social needs beyond financial metrics like income may help providers discern more financial stressed families, even amongst a homogeneously low-income community. The next step will be to develop resources around these needs.