Community Support Worker Assistance for Poverty

Overseen By Cornelia Borkhoff

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Kingston Health Sciences Centre

Disqualifiers: No legal status, System support, Developmental disorder, Premature birth

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

80 Participants Needed

Trial Summary

What is the purpose of this trial?

Living in poverty has a profound negative impact on parenting stress and children's health. When poverty occurs early in childhood and continues for a long time, the impact on child health can be lifelong. Child poverty is common, affecting about 20% of Canadian children. Many low income families may not be receiving all the social benefits for which they are eligible. There are calls for primary care providers to ask patients if they have difficulty making ends meet at the end of the month and to intervene if poverty is identified, but it is not known if intervening can improve parent's and children's health. This study will test whether a Community Support Worker who helps families with young children navigate the social service system by reviewing social needs (like food, housing or energy insecurity) and income supports can lead to increased family income, reduced parenting stress and an improvement in their child's health. The Community Support Worker will help families complete income tax, apply for benefits and community supports for which they are eligible. The investigators will also study the effect of this intervention on health care utilization. Our study will be conducted in Toronto and Kingston in primary care practices participating in the TARGet Kids! primary care research network. Results from this study will help health care providers and policy makers understand whether Community Support Workers are an effective way to integrate the health and social service systems to improve parent and child health.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Community Support Worker Assistance for Poverty?

Research shows that community health worker interventions can improve access to primary care and reduce hospital readmissions by addressing socioeconomic and behavioral factors, which suggests that similar support from community workers could be effective in assisting individuals facing poverty. ^{1 2 3 4 5}

Is the Community Support Worker Intervention safe for humans?

The research does not provide specific safety data for the Community Support Worker Intervention, but it highlights the importance of training and supervision to ensure effective and safe delivery of services. ^{6 7 8 9 10}

How is the Community Support Worker treatment different from other treatments for poverty?

The Community Support Worker treatment is unique because it involves trained individuals providing hands-on support and guidance to help people navigate social services and community resources, which is not typically part of standard medical treatments. This approach focuses on addressing socioeconomic barriers and improving quality of life, rather than just medical symptoms. ^{11 12 13 14 15}

Eligibility Criteria

This trial is for parents in Canada who struggle to make ends meet each month, have children under 3 years old attending regular primary care visits, and can give informed consent. It's not for families already getting navigation support, those without legal status in Canada, or with a child born prematurely or with certain health conditions.

Inclusion Criteria

Informed parental consent

My family struggles financially towards the end of the month.

I am a parent of a child under 3 years old attending a regular health check-up.

Exclusion Criteria

Child born prematurely (gestational age less than 32 weeks)

Parents without legal status in Canada, as they are not eligible for many Canadian social programs

Families who are receiving system navigation support, such as from a social worker or public health nurse, or who have received system navigation support within one year prior to enrolment

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Intervention

Families receive a structured review of income supports with a Community Support Worker to identify financial needs and benefits

6 months

Visits conducted in person, by telephone, or by videoconferencing

Follow-up

Participants are monitored for changes in parenting stress, household income, food security, and health care utilization

6 months

Data collection through questionnaires and administrative databases

Extended Follow-up

Continued monitoring of secondary outcomes such as child development and parent health system utilization

12 months

Treatment Details

Interventions

• Community Support Worker
• Usual Care

Trial Overview The study tests if a Community Support Worker helping low-income families navigate social services improves family income, reduces parenting stress, and betters child health. The worker assists with tax filing and applying for benefits. The impact on healthcare use will also be evaluated.

Participant Groups

Group I: Community Support Worker Experimental Treatment 1 Intervention

structured review of participant income supports with a trained CSW, to identify financial needs and benefits for which the family is eligible, including assessment of income and food security, affordability of medications, housing and energy insecurity, and dental care. The visits will be conducted in person, by telephone or by videoconferencing, according to participant preference and to ensure adherence to COVID-19 pandemic-related criteria.

Group II: Usual Care Active Control 1 Intervention

There is no clear standard of care and potential for practice variation in clinician responses to identified social need. Based on the ethical imperative to provide some support to families who identify unmet social needs, the comparator group will receive Usual Care, defined as: Participants in both groups will receive a written summary of available resources.

Who Is Running the Clinical Trial?

Kingston Health Sciences Centre

Lead Sponsor

Trials

312

Recruited

112,000+

Queen's University

Lead Sponsor

Queen's University

Lead Sponsor

Trials

382

Recruited

122,000+

Findings from Research

The community health worker (CHW) program helped 1600 frequent emergency department users in Buffalo, New York, achieve 43% of their health-related objectives, primarily focused on connecting clients to community resources and primary care.

Success in achieving these objectives was linked to higher client engagement with CHW services, indicating that improving access to resources and addressing systemic barriers could enhance the program's effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Community Health Workers: Addressing Client Objectives Among Frequent Emergency Department Users. Kwan, BM., Rockwood, A., Bandle, B., et al.[2019]

A tailored community health worker (CHW) intervention significantly improved posthospital outcomes for low-socioeconomic status patients, increasing timely primary care follow-up from 47.9% to 60.0% and enhancing the quality of discharge communication.

The intervention also led to better mental health improvements and patient activation, while reducing the likelihood of multiple 30-day readmissions, indicating that CHWs can effectively address socioeconomic and behavioral factors affecting recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial. Kangovi, S., Mitra, N., Grande, D., et al.[2018]

Improving treatment adherence is crucial for reducing health issues and costs, especially among low-income and minority patients, as it involves complex interactions between patients, providers, and health systems.

The paper outlines five key elements for a best practice case management approach, supported by theory and evidence, and highlights the SAFe program, which has successfully enhanced adherence in patients with abnormal cancer screenings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Best practice case management for improved medical adherence. Vourlekis, B., Ell, K.[2007]

A social work-led care coordination intervention significantly reduced hospital readmission rates by 22% among moderate- and high-risk patients aged 50 and older, based on a randomized controlled trial with 89 participants.

The intervention, which included one home visit and one to two phone calls from a Master of Social Work intern, showed a highly statistically significant improvement in preventing readmissions (p = .003), suggesting its potential effectiveness in post-discharge care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of a Social Work Care Coordination Intervention on Hospital Readmission: A Randomized Controlled Trial. Bronstein, LR., Gould, P., Berkowitz, SA., et al.[2022]

The study highlights the importance of psychosocial factors and social work interventions in improving health outcomes for dialysis patients, emphasizing the complexity of their care.

By utilizing an interdisciplinary research team and analyzing data over time, the project showcases how social workers play a crucial role in enhancing patient outcomes in dialysis treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dialysis patient characteristics and outcomes: the complexity of social work practice with the end stage renal disease population. Dobrof, J., Dolinko, A., Lichtiger, E., et al.[2018]

The Strong Beginnings program successfully defined 28 specific interventions for community health workers (CHWs) to improve maternal and child health, categorized into seven core functions based on risk topics.

This structured approach not only enhances the clarity of the CHW role within healthcare teams but also promotes consistent care delivery and supports the sustainability of the program by linking CHW contributions to health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Defining the Role of the Community Health Worker within a Federal Healthy Start Care Coordination Team. Raffo, JE., Lloyd, C., Collier, M., et al.[2023]

The study found that while South Africa's policy documents recognize the importance of supportive supervision for community health workers (CHWs), they lack detailed guidance and alignment, which hampers effective implementation.

Supervision practices are inconsistent and often informal, leading to strained relationships between community health worker teams and primary health care clinic managers, ultimately affecting the performance and sustainability of the ward-based outreach team strategy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

National guidance and district-level practices in the supervision of community health workers in South Africa: a qualitative study. Assegaai, T., Schneider, H.[2020]

The Sure Start initiative, which aims to support pre-school children and families in deprived areas, has shown that health support workers can effectively enhance service delivery under the supervision of health visitors, leading to positive outcomes for families.

Qualitative feedback from health visitors and service users indicates that while the contributions of health support workers are valued, there are significant concerns regarding their training and supervision that need to be improved for better service effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A research evaluation of health support workers in a Sure Start project. Smith, C., Prosser, M., Joomun, L.[2019]

A 12-month home-based intervention led by community health workers (CHWs) did not significantly lower HbA1c levels for the overall group of low-income adults with diabetes compared to usual care, indicating limited efficacy in the general population.

However, for participants with very high HbA1c levels (greater than 10%), the intervention resulted in a significant decrease in HbA1c, suggesting that CHW support may be particularly beneficial for those with poor glycemic control.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized Controlled Trial of a Community Health Worker Self-Management Support Intervention Among Low-Income Adults With Diabetes, Seattle, Washington, 2010-2014. Nelson, K., Taylor, L., Silverman, J., et al.[2022]

The COMPASS program, a peer-led intervention for home care workers, significantly enhanced professional support networks and improved safety and health behaviors, as shown in a randomized controlled trial.

Qualitative interviews with 28 participants highlighted the unique physical and psychological challenges faced by workers, as well as the importance of COMPASS in addressing resource limitations and providing support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Protecting workers in the home care industry: workers' experienced job demands, resource gaps, and benefits following a socially supportive intervention. Mabry, L., Parker, KN., Thompson, SV., et al.[2019]

Community support workers play a crucial role in mental health services by providing intensive support to individuals with severe mental illness.

The effectiveness of these workers can be enhanced through proper training, highlighting the importance of investing in their education and skill development.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mental health. Sending in the paras. Johnson, S., Brooks, L., Sutherby, K., et al.[2018]

An in-home intervention led by community health workers (CHWs) significantly improved physical activity and dietary behaviors in low-income adults with diabetes over 12 months, compared to usual care.

The study suggests that integrating CHWs into diabetes care can effectively support lifestyle changes, although the mechanisms behind these changes need further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improvements in physical activity and some dietary behaviors in a community health worker-led diabetes self-management intervention for adults with low incomes: results from a randomized controlled trial. Gray, KE., Hoerster, KD., Taylor, L., et al.[2022]

Community health workers (CHWs) played a crucial role in a diabetes self-management intervention for low-income individuals, addressing barriers such as lack of diabetes knowledge, socioeconomic challenges, and healthcare system complexity through personalized education and support.

The study analyzed 634 encounter reports from 145 participants, highlighting that CHWs provided essential resources and guidance, demonstrating their effectiveness in improving diabetes management beyond what typical primary care can offer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Value of Community Health Workers in Diabetes Management in Low-Income Populations: A Qualitative Study. Silverman, J., Krieger, J., Sayre, G., et al.[2022]

The community outreach workers (CWs) program in rural British Columbia effectively supported marginalized clients, resulting in a 41% reduction in emergency department visits and facilitating 142 connections to healthcare providers.

Despite serving clients who often fell outside traditional health services, the program demonstrated its importance by slightly increasing primary care service usage and helping clients navigate the healthcare system more effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evidence-based support for community outreach worker programme in Rural British Columbia, Canada. Szelest, I., Black, C., Brown, SM., et al.[2022]

The study evaluated the impact of community support workers (CSWs) on patients with severe mental illness over a 6-month period, showing improvements in service satisfaction, quality of life, and social behavior.

CSWs did not increase overall service costs and were linked to a reduction in inpatient care, suggesting they effectively support patients in community settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes and costs of a community support worker service for the severely mentally ill. Clarkson, P., McCrone, P., Sutherby, K., et al.[2019]

References

1. United States pubmed.ncbi.nlm.nih.gov

Community Health Workers: Addressing Client Objectives Among Frequent Emergency Department Users. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Best practice case management for improved medical adherence. [2007]

4. United States pubmed.ncbi.nlm.nih.gov

Impact of a Social Work Care Coordination Intervention on Hospital Readmission: A Randomized Controlled Trial. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Dialysis patient characteristics and outcomes: the complexity of social work practice with the end stage renal disease population. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

Defining the Role of the Community Health Worker within a Federal Healthy Start Care Coordination Team. [2023]

7. England pubmed.ncbi.nlm.nih.gov

National guidance and district-level practices in the supervision of community health workers in South Africa: a qualitative study. [2020]

8. England pubmed.ncbi.nlm.nih.gov

A research evaluation of health support workers in a Sure Start project. [2019]

9. United States pubmed.ncbi.nlm.nih.gov

Randomized Controlled Trial of a Community Health Worker Self-Management Support Intervention Among Low-Income Adults With Diabetes, Seattle, Washington, 2010-2014. [2022]

10. England pubmed.ncbi.nlm.nih.gov

Protecting workers in the home care industry: workers' experienced job demands, resource gaps, and benefits following a socially supportive intervention. [2019]

11. England pubmed.ncbi.nlm.nih.gov

Mental health. Sending in the paras. [2018]

12. England pubmed.ncbi.nlm.nih.gov

Improvements in physical activity and some dietary behaviors in a community health worker-led diabetes self-management intervention for adults with low incomes: results from a randomized controlled trial. [2022]

13. Netherlands pubmed.ncbi.nlm.nih.gov

The Value of Community Health Workers in Diabetes Management in Low-Income Populations: A Qualitative Study. [2022]

14. India pubmed.ncbi.nlm.nih.gov

Evidence-based support for community outreach worker programme in Rural British Columbia, Canada. [2022]

15. United States pubmed.ncbi.nlm.nih.gov

Outcomes and costs of a community support worker service for the severely mentally ill. [2019]