A review of the effectiveness and experiences of welfare advice services co-located in health settings: A critical narrative systematic review

Exploring the feasibility of evaluating a community alliance welfare advice programme co-located in primary care in Bradford: an uncontrolled before and after study

BACKGROUND

Welfare advice services co-located in health settings are known to improve financial security. However, little is known on how to effectively evaluate these services. This study aims to explore the feasibility of evaluating a welfare advice service co-located in a primary care setting in a deprived and ethnically diverse population. It seeks to investigate whether the proposed evaluation tools and processes are acceptable and feasible to implement and whether they are able to detect any evidence of promise for this intervention on the mental health, wellbeing and financial security of participants.

METHODS

An uncontrolled before and after study design was utilised. Data on mental health, wellbeing, quality of life and financial outcomes were collected at baseline prior to receiving welfare advice and at three months follow-up. Multiple logistic and linear regression models were used to explore individual differences in self-reported financial security and changes to mental health, wellbeing and quality of life scores before and after the provision of welfare advice.

RESULTS

Overall, the majority of key outcome measures were well completed, indicating participant acceptability of the mental health, wellbeing, quality of life and financial outcome measures used in this population. There was evidence suggestive of an improvement in participant financial security and evidence of promise for improvements in measured wellbeing and health-related quality of life for participants accessing services in a highly ethnically diverse population. Overall, the VCS Alliance welfare advice programme generated a total of £21,823.05 for all participants, with participants gaining an average of £389.70 per participant for participants with complete financial outcome data.

CONCLUSIONS

This research demonstrates the feasibility of evaluating a welfare advice service co-located in primary care in a deprived and ethnically diverse setting utilising the ascribed mental health, wellbeing and quality of life and financial outcome tools. It provides evidence of promise to support the hypothesis that the implementation of a welfare advice service co-located in a health setting can improve health and wellbeing and reduce health inequalities.

Money Matters: Time for Prevention and Early Intervention to Address Family Economic Circumstances

Child poverty is associated with poorer physical and mental health, negative educational outcomes and adverse long-term social and psychological consequences, all of which impact on service demand and expenditure. Until now, however, prevention and early intervention practice has tended to focus on enhancing inter-parental relationships and parenting skills (e.g., via relationship skills education, home visiting, parenting programs, family therapy) or child language, social-emotional and life skills (e.g., early childhood education, school-based programs, youth mentoring). Programs often target low-income neighborhoods or families but rarely address poverty directly. While there is substantial evidence for the effectiveness of such interventions in improving child outcomes, null results are not uncommon and even positive effects are often small, short-term, and difficult to replicate. One avenue to enhance intervention effectiveness is to improve families' economic circumstances. There are several arguments for this refocusing. It is arguably unethical to focus on individual risk without acknowledging or seeking to address (where relevant) families' social and economic contexts, while the stigma and material constraints associated with poverty can make it harder for families to engage with psychosocial support. There is also evidence that increasing household income improves child outcomes. Although national policies to alleviate poverty are important, it is increasingly recognized that practice-based initiatives have a role to play (e.g., income maximization, devolved budgets, money management support). However, knowledge about their implementation and effectiveness is relatively thin. For instance, there is some evidence that co-located welfare rights advice in healthcare settings can improve recipients' financial circumstances and health, but it is mixed and of limited quality. Moreover, there is little rigorous research on whether and how such services affect mediators (parent-child interactions, parenting capacity) and/or child physical and psychosocial outcomes directly. We call for prevention and early intervention programs to attend more to families' economic circumstances, and for experimental studies to test their implementation, reach and effectiveness.