Healthier Wealthier Families (HWF) trial: supporting families with young children through financial counselling in well-child heathcare home visits

Intervention: Healthier Wealthier Families (HWF) connects well-child healthcare with community-based financial counselling to provide an early intervention for financial hardship for families with young children. This protocol describes a pragmatic randomised controlled trial (RCT) of the HWF model embedded in well-child home visits in the Australian state of Queensland. The home visiting model that HWF is being embedded in is known as the Maternal Early Childhood Sustained Home-visiting (MECSH) Program. The HWF intervention comprises 3 components: (1) MECSH providers ask all clients about financial hardship in surveys conducted within the home visiting program. (2) MECSH clients (usually the biological mother) who are experiencing financial hardship, will be offered a referral to the MECSH provider to financial counselling. (3) MECSH clients who agree to a referral will be contacted directly by phone by the financial counselling service. In Australia, financial counselling is a specialised profession that requires accreditation with a state-based peak body, a supervised training period, and ongoing professional development (e.g. trauma-informed care, responding to family violence). Financial counsellors work on a client’s behalf and are not mandated to report client activities to government. Clients have as many appointments with a financial counselor as they need to achieve their goals. Recruitment and procedure: MECSH providers collect routine data on demographics and contacts with MECSH (home, other, telehealth), and support clients to complete implementation surveys at enrolment (pregnancy to 8 weeks postpartum), 6 and 22-23 months postpartum. The HWF financial hardship screening items will be embedded into the MECSH surveys for all clients, as per allocation, plus new HWF-specific surveys asked at 12 and 18 months. This means that all caregivers in Group 1 ('now', intervention) are asked the financial questions in each MESCH survey they complete, from month 1-24 post-randomisation, and all caregivers in Group 2 ('next', control) are asked the financial screen in each MESCH survey they complete, from month 13-24 post-randomisation. All MECSH and HWF surveys collect caregiver-reported mental health using the Matthey Generic Mood Questionnaire (see Measures). For clients who report financial hardship, the MECSH provider describes the financial counselling available and asks if the caregiver agrees to the HWF referral. Recording a client’s agreement in the online MECSH database automatically sends a referral email to the financial counsellor, to contact the client and do a standard intake assessment. The MECSH provider also asks if the caregiver consents to data sharing for the purposes of evaluating HWF. These processes were used in the feasibility pilot, where all referred clients consented to data sharing.