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

Jane Drummond, Natasha Wiebe, Sylvia So, Laurie Schnirner, Jeffrey Bisanz, Deanna L Williamson, Maria Mayan, Laura Templeton, Konrad Fassbender, Community-University Partnership for the Study of Children, Youth, and Families, Jane Drummond, Natasha Wiebe, Sylvia So, Laurie Schnirner, Jeffrey Bisanz, Deanna L Williamson, Maria Mayan, Laura Templeton, Konrad Fassbender, Community-University Partnership for the Study of Children, Youth, and Families

Abstract

Background: Increasing 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.

Methods: We 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.

Results: We 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).

Conclusions: Our 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 registration: ClinicalTrials.gov, NCT00705328 . Registered on 24 June 2008.

Figures

Fig. 1
Fig. 1
Participant family flow diagram. LFU loss to follow-up
Fig. 2
Fig. 2
Rate ratios of family services linkages by intervention group and type of service. The boxes represent the point estimates of the rate ratios in family service linkages between participant families in intervention groups versus participant families in the Self-Directed group. The whiskers represent the upper and lower confidence limits of the rate ratios. Confidence intervals that cross the line where the horizontal rate ratio equals 1 are significant at P < 0.05. Purple markers depict the Comprehensive group (versus the Self-Directed group); red markers depict the Family Healthy Lifestyle group (versus the Self-Directed group); and blue markers represent the Family Recreation group (versus the Self-Directed group). Rate ratios are adjusted for baseline service linkage rate, income group (income support versus other), and follow-up visit year. FSI Family Services Inventory

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