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

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-integrati...

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Autores principales: Drummond, Jane, Wiebe, Natasha, So, Sylvia, Schnirner, Laurie, Bisanz, Jeffrey, Williamson, Deanna L., Mayan, Maria, Templeton, Laura, Fassbender, Konrad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957834/
https://www.ncbi.nlm.nih.gov/pubmed/27449358
http://dx.doi.org/10.1186/s13063-016-1444-8
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author Drummond, Jane
Wiebe, Natasha
So, Sylvia
Schnirner, Laurie
Bisanz, Jeffrey
Williamson, Deanna L.
Mayan, Maria
Templeton, Laura
Fassbender, Konrad
author_facet Drummond, Jane
Wiebe, Natasha
So, Sylvia
Schnirner, Laurie
Bisanz, Jeffrey
Williamson, Deanna L.
Mayan, Maria
Templeton, Laura
Fassbender, Konrad
author_sort Drummond, Jane
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-016-1444-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-49578342016-07-23 Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial Drummond, Jane Wiebe, Natasha So, Sylvia Schnirner, Laurie Bisanz, Jeffrey Williamson, Deanna L. Mayan, Maria Templeton, Laura Fassbender, Konrad Trials Research 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-016-1444-8) contains supplementary material, which is available to authorized users. BioMed Central 2016-07-22 /pmc/articles/PMC4957834/ /pubmed/27449358 http://dx.doi.org/10.1186/s13063-016-1444-8 Text en © Drummond et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Drummond, Jane
Wiebe, Natasha
So, Sylvia
Schnirner, Laurie
Bisanz, Jeffrey
Williamson, Deanna L.
Mayan, Maria
Templeton, Laura
Fassbender, Konrad
Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial
title Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial
title_full Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial
title_fullStr Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial
title_full_unstemmed Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial
title_short Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial
title_sort service-integration approaches for families with low income: a families first edmonton, community-based, randomized, controlled trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957834/
https://www.ncbi.nlm.nih.gov/pubmed/27449358
http://dx.doi.org/10.1186/s13063-016-1444-8
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