P0682 - Improving families' health, education, and financial outcomes with an incentives-based savings program in a pediatric clinic

Background:
Prior to COVID-19, two out of five people in the US could not cover a $400 emergency. Now, many more families are struggling financially. Families with low income often don’t seek needed healthcare, risking poor health outcomes. Minority families, in particular, suffer health inequities stemming from disparities in social capital, income, and education. Higher education improves long-term economic success, but low-income families have difficulty saving for their children’s futures. Children’s Savings Account (CSA) programs, which provide higher education savings to children in early childhood, have increased families’ college expectations and improved mothers’ mental health and children’s socio-emotional development.

Methods:
We assessed parents’ perceptions of and access to preventive healthcare, as well as the educational goals they have for their children. We conducted qualitative interviews with 13 parents meeting the following criteria: (1) at least one child age 3 or younger, (2) maximum income at 185% of the federal poverty level, and (3) no parent with an advanced degree (e.g. master’s). We will interview seven more parents by December 2020.

Meanwhile, we designed Early Bird, a first-of-its-kind health clinic-based CSA program that rewards families for achieving healthy milestones—such as attending pediatrician and dentist appointments, meeting with a financial coach, and enrolling in pre-Kindergarten—with scholarship funds in their children’s CSAs. We are launching a 3-year longitudinal randomized study to evaluate this novel model.

Results:
All parents interviewed would participate in a milestone-based CSA program through their health clinic. All hoped their child(ren) would attend college, 85% perceived financial barriers to higher education, and 69% worried that not attending college would limit their child’s career. Only 23% of participants had savings for college. Participants’ self-described ethnicities were 85% Hispanic or Latino, 7.5% Black or African American, 7.5% American Indian or Alaska Native, and 7.5% White/Caucasian.(1)

Philanthropic funds were raised to support the launch of Early Bird’s pilot serving 300 children, including scholarships up to $500 per child. Contracted partners include a federally-qualified health center, a financial coaching service provider, a 529 account management system provider, and a local nonprofit that will administer the scholarship accounts. The program will launch in 2020.

Discussion:
Parents with low income desire higher education for their children but struggle to save money. This new model aligns short-term achievements during early childhood in health, education, and family finances with long-term goals for higher education and career success. This study informs a replicable model with potential to improve health, education, and financial outcomes nationally. Early Bird aligns many milestone achievements with the priorities of health insurance payers, which may aid long-term financial sustainability. Feasibility studies are needed to further assess the model’s viability in differing clinical settings.

(1) Totals more than 100% due to multi-select answer format.