Ameliorating Child poverty through Connecting Economic Services with child health Services (ACCESS): A randomised controlled trial of the Healthier Wealthier Families model in Sweden

Background: Poverty is one of the most basic and persistent causes of early childhood adversity.

In the first years of life, a critical developmental period, children living in, or on the verge of, poverty are the most vulnerable to its damaging impact on future health and wellbeing, cognitive development, educational attainment, employment, and societal participation.The proportion of Swedish children living in poverty has increased two-fold since 2000.

Recent figures indicate that 17% of children in Sweden live in poverty according to the EU-standard. Effective interventions are needed to help families who live in poverty to improve their economic situation.

Sweden is a welfare state and a number of services and benefits are available to struggling families: all municipalities in Sweden are e.g. required to provide free financial counselling under the Social Services Act. The service supports families to access benefits they are entitled to, manage debt and improve financial control.

Problem: Structural and perceptual barriers, such as literacy and social stigma, affect access to the service.

A universal and non-stigmatising access point could overcome this problem.Objective: We will examine the effectiveness and cost-effectiveness of ‘Healthier Wealthier Families’ (HWF), a service model that uses the child health services as an access point to link families with the municipal financial counselling service.Prel.

Results: Preliminary work has indicated promise for HWF as operative in Sweden. Screening and referral processes have been co-designed with child health nurses, financial counsellors and families.

Two pilot sites have been established and a process evaluation is underway.Strategy: We plan to conduct a two-arm randomised waitlist-control superiority trial and longitudinal cohort study.Significance: HWF is a collaborative and sustainable model that could maximise the effectiveness of current services to address poverty, one of the main childhood adversities.