Resource navigation in primary care during the first year of life: The streetcred economic bundle

Public economic resources reduce the impact of poverty on health but are underused and challenging to access, particularly for families from marginalized racial and ethnic groups. We describe the development of a clinically embedded program (the economic bundle) that facilitates enrollment in the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), on-site food pantries, free tax preparation, 529 college savings accounts (CSAs), paid family and medical leave (PFML), and the US Department of Housing and Urban Development's Family Self-Sufficiency (FSS) Program. We designed this economic bundle in response to our pediatric primary care clinic patient population's needs (85% Medicaid-insured, 30% immigrants, 68% Black/African American or Hispanic/Latinx). We delivered services using navigators embedded into routine well-child visits throughout the first year of life. We performed a retrospective review of the program's first 14 months (April 2022 to June 2023) to describe the program's design, implementation, and early outcomes. Among the 311 families who received the service, few eligible families were enrolled in the offered economic resources at the newborn visit (WIC 31%, SNAP 23%, food pantry 17%, PFML 37%, tax preparation 21%, 529 CSA 1%, and FSS 7%). Among families whose infants were aged at least 6 months at the time of follow-up and were eligible but unenrolled at the newborn visit, many subsequently were enrolled in WIC (59%), SNAP (41%), on-site food pantry (39%), PFML (26%), and 529 CSAs (4%); 12% utilized tax preparation services. Our economic bundle is a promising approach to support families' economic stability throughout the first year of a child's life.