Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial

Abstract

BackgroundIncreasing access to health and social services through service-integration approaches may provide a direct and sustainable way to improve health and social outcomes in low-income families.MethodsWe did a community-based randomized trial evaluating the effects of two service-integration practices (healthy family lifestyle and recreational activities for children) among low-income families in Alberta, Canada. These two practices in combination formed four groups: Self-Directed (no intervention), Family Healthy Lifestyle, Family Recreation, and Comprehensive (Family Healthy Lifestyle plus Family Recreation programs). The primary outcome was the total number of service linkages.ResultsWe randomized 1168 families, 50 % of which were retained through the last follow-up visit. The number of service linkages for all three intervention groups was not significantly different from the number of linkages in the Self-Directed group (Comprehensive 1.15 (95 % CI 0.98–1.35), Family Healthy Lifestyle 1.17 (0.99–1.38), and Family Recreation 1.12 (0.95–1.32) rate ratios). However, when we explored the number of linkages by the categories of linkages, we found significantly more healthcare service linkages in the Comprehensive group compared to the Self-Directed group (1.27 (1.06–1.51)) and significantly more linkages with child-development services in the Family Healthy Lifestyle group compared to the Self-Directed group (3.27 (1.59-6.74)). The monthly hours of direct intervention was much lower than the assigned number of hours (ranging from 5 to 32 % of the assigned hours).ConclusionsOur findings are relevant to two challenges faced by policymakers and funders. First, if funds are to be expended on service-integration approaches, then, given the lack of intervention fidelity found in this study, policymakers need to insist, and therefore fund a) a well-described practice, b) auditing of that practice, c) retention of family participants, and d) examination of family use and outcomes. Second, if child-development services are widely required and are difficult for low-income families to access, then current policy needs to be examined.Trial registrationClinicalTrials.gov, NCT00705328. Registered on 24 June 2008.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1444-8) contains supplementary material, which is available to authorized users.

Models, theoretical design and formal evaluation of integrated specialist community health service provision for the first 2000 days: a scoping review

“…Community workers or peer support workers encouraged engagement of parents with the service, reduced stigma and increased the sense of connection to other parents with similar circumstances 22 25 26. Coordination between programmes supported a better use of available resources by addressing several risk areas rather than providing single interventions in silos 19 25 27. This requires a willingness of staff to embrace new roles and responsibilities, engage in professional learning, contribute with mutual respect and recognition of different expertise, priorities and common values 17.…”

“…Interdisciplinary care is supported by recruitment, induction and ongoing professional development of staff, supporting a shared ethos and strong working relationships 17. In working with families, a family-centred and trauma informed approach supports integrated care 17 22 25 27…”

“…Interventions were evaluated using action research, qualitative and quantitative methods. Drummond et al 27 used action research cycles with qualitative analysis. Qualitative data were also obtained through case studies,23 thematic analysis of storytelling by Australian Aboriginal peoples21 and interviews with parents 26 28…”

“…Outcomes used to evaluate interventions: Outcomes were reported using qualitative and quantitative methods. In one intervention, a purposely designed tool, the ‘Family Services Inventory’, was used to guide measurement and reporting of total family linkages to health and social services 27. The ‘Core Care Conditions for Children and Families’ template39 was designed to evaluate how well child and family needs were met in centres dedicated to integrated care.…”

The Internal-External Dynamic: Using Research to Inform Government Policy about Poverty in Canada

“…In 2005, the partnership secured funding from the Canadian Institutes of Health Research and the Alberta Heritage Foundation for Medical Research to develop a community-based research study. The partnership proposed to conduct a randomized control trial that evaluated the impact of different forms of service delivery to low-income families (Drummond et al, 2016). As the partnership gained momentum, a governance structure was implemented to guide decision-making and other local organizations joined and participated in the design and implementation of the research project, including Bent Arrow Traditional Healing Society, Kara Family Resource Centre, the Multicultural Health Brokers Co-Op, and YMCA of Edmonton.…”