How financial counseling at the pediatrician's office can help families thrive

In 2018, Chris and Daisy Quitco of Compton, Calif., had a baby girl. When they brought her to the pediatrician for a one-month checkup, they expected to encounter doctors, crying babies and flu shots. They didn't expect to see a personal finance coach in the exam room.

For the Quitcos, it turned out to be a lifeline – a well-timed intervention that helped stabilize their finances. "We never expected to walk into a clinic and be able to speak to someone about what we're going through, especially our life experiences and debt," Chris Quitco says.

At the time, he worked as a repairman, making $18 an hour. Daisy stayed home with the baby. They had a load of debt and bad credit scores.

"We were just living paycheck to paycheck," Daisy Quitco says, "The financial counseling helped us prioritize what is a need, what is a want and to prioritize saving money too."

The Quitcos had come across an experimental program at the Harbor-UCLA Medical Center, which pairs low-income parents with financial coaches to help address some of the biggest problems these parents face.

"Poverty drives health outcomes, especially poverty in early childhood," says Dr. Adam Schickedanz, a pediatrician and researcher at UCLA who co-directs the medical-financial partnership. "Food insecurity, housing insecurity, transportation issues, utility bills, all have a financial component at their core."

The idea is that helping new parents address their financial stressors at a crucial time in infancy, it can improve their children's health, says Monique Holguin, a social worker and researcher at UCLA who co-directs the program with Schickedanz.

"Starting early, in the first few years of life, cements a pathway towards financial security," she says. "It helps to break the intergenerational cycles of poverty that impact long-term health consequences for that child, and for many family members as well."

Evidence that financial coaching helps

The financial coaching experiment started in 2018 at Harbor-UCLA's pediatric primary care clinic. Schickedanz and Holguin's team recruited 81 families with new babies. Half were paired with personal financial coaches, while the other half received regular care.

And real benefits soon emerged. A paper, published this month in the journal Pediatrics, finds the families who worked with financial coaches came to more of the recommended preventive care visits and missed fewer vaccinations in the baby's first six months. They also increased their average income by over $1,700 a month, and they saved an average of $850 per month – netting much more each month than those without financial coaches.

"Our wheelhouse goes beyond acute stressors, beyond responding to food shortages and housing needs," says Holguin. "We work with families on long-term [plans] to help prevent those stressors from occurring again, and promote long-term stability."

The coaches provide financial counseling to parents at their babies' medical appointments and call or text them monthly, to help them establish financial goals and plans to reach them.

In 2018, when Chris Quitco joined the program, his credit score was very poor. When the financial coach asked what goals he had, Quitco says, "I told them I wanted to eliminate some of my debt, possibly find another source of income." He soon picked up some additional income driving for Uber. And the coach taught them to consolidate his debt, to "tackle it little by little so that we wouldn't be overwhelmed," and to start a savings fund.

The coaches also connect parents with resources that help them pay for food and utilities – and follow-up to make sure they're able to use the services. "As a coach, one of the most important things is following through, and being a consistent, positive support for the families," says Marikit Mendiola, a former financial coach who worked with the Quitcos, and now coordinates research and evaluation for the program

With Mendiola's help, the Quitcos got free daycare for their daughter through the Early Head Start program. That's allowed Daisy to start working towards her nursing license. Chris got promoted at work, and he's improved his credit score to near-perfect.

The program is designed to last for two years. The Quitcos have found it so helpful that they keep coming back. "We've actually graduated twice, but we insisted on staying with them. There's so much resources and help we get from them that it's hard to leave," Chris says.

A challenge: making support for patients sustainable

The evidence suggests that many families find value in having a financial coach. This research adds to a body of research that shows that non-medical support, like social workers, can help improve the patient's health care experience, says Dr. Tumaini Coker, a pediatrician and researcher at the University of Washington who is not affiliated with the study.

"When you expand the team that's providing care for families in early childhood, you can make the well-child experience more meaningful. And when people find things more meaningful, they come," she says. Still, Coker says, the challenge is getting non-medical workers paid for in a health care setting, in a sustainable way.

For the UCLA study, the researchers managed the staffing costs by using social workers in training, whose work as financial coaches helps fulfill a supervised fieldwork requirement they need to graduate. "You can have a relatively sizable team of coaches at the cost of a single individual staff member," Schickedanz says, since the main staffing cost is the supervisors' time, "We think it's more scalable with this structure."

The financial coaching program is "a cool idea," says Peter Muennig, a professor of health policy and management at Columbia University Mailman School of Public Health, who was not involved with the study. He says it's a promising addition to a boom in research over the past decade addressing the economic and environmental conditions that affect health.

"This is the kind of intervention that might work in any clinical setting," he says. Still, it's a small study, driven by people who care deeply about the project – he cautions against assuming that the same good results could be easily replicated.

For the Quitcos, financial counseling has improved their ability to keep their child healthy. "We're able to keep a roof over our head, we're able to provide clothing and healthy foods," Daisy says.

It's also improved their own health. "My stress level has gone down, practically depleted to nothing," says Chris. Even with a young child, "I sleep more well than I ever have."

At 38 years old, Chris says he's on solid financial ground for the first time in his life. Finally, he can relax and enjoy the time he spends with his family.