What does integrated care for families in poverty look like in practice? Insights from professionals’ support diaries

Background: Poverty is about more than just finances: it affects housing, health, work, school, social connections, and both parents and children. Integrated care for families in poverty aims to helps parents and children with all of their needs. We studied what support activities are actually provided, and whether parents and children are involved.

 

Approach: This study was conducted in collaboration with 11 organizations in Rotterdam, the Netherlands, that provide integrated care to families in poverty. Nineteen professionals supporting 26 families experiencing poverty were followed over an average period of 3.5 months. We examined which activities professionals engaged in, and which life domains and family members were included. After each meeting with the parent, professionals sent an update to the researcher about the support provided during that meeting. These updates were compiled into case records, and analysed using a thematic coding approach. We grouped the activities performed by the professional into overarching themes from which life domains could be identified.

 

Additionally, for each update, we coded which family members were included in the provided support. The study materials and design, including consent procedures and study duration, were evaluated and approved by people with lived experience of living in poverty, and by professionals providing support to families in poverty.

 

Results: A total of 240 updates were analysed. Of the support mentioned in these updates, 72% focused on parents, 17% on both parent and child, 7% on the family as a whole, and 4% on children specifically. The most frequently observed professional activities involved a) making practical arrangements (such as applying for financial aid and support with housing-related matters), b) contacting external organizations (such as the Tax Authority, municipality and utility companies), and c) conversations and advice for parents (including conversations about feelings and stress, finances, healthcare and housing).

 

A variety of life domains were represented, including financial, housing, work, mental and physical health, parenting, education, legal and social network domains. However, most support was provided in the financial domain, sometimes in combination with another domain (for instance with health, when contacting a health insurance company about payment arrears).

In terms of family members, support was mostly aimed at the parent. Child-focused support often indirectly benefited children (for instance through parenting advice). When children were directly involved, support was often practical in nature, and focused on financial and education domains (such as cancelling a child’s bank account).

 

Implications: In practice, professionals support families in various life domains, although support in the financial domain was most common, highlighting how poverty permeates every aspect of families’ lives. Additionally, support is mainly aimed at the parent(s). Although supporting parents indirectly benefits children, identifying the needs of children growing up in poverty is essential, as professionals are uniquely positioned to support children, help them thrive and buffer them against the negative consequences of poverty. These findings highlight the importance of strengthening child-focused approaches within integrated family support and are relevant for policy and practice.