title: Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  ClinicalTrials.gov, NCT00705328 . Registered on 24 June 2008.
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, T6G 1C9, Alberta, Canada. jane.drummond@ualberta.ca.
authors.forename: Jane
authors.initials: J
authors.lastname: Drummond
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Natasha
authors.initials: N
authors.lastname: Wiebe
authors.affiliation: Alberta Health Services, Edmonton, Canada.
authors.forename: Sylvia
authors.initials: S
authors.lastname: So
authors.affiliation: Faculty of Extension, University of Alberta, Edmonton, Canada.
authors.forename: Laurie
authors.initials: L
authors.lastname: Schnirner
authors.affiliation: Department of Psychology, University of Alberta, Edmonton, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bisanz
authors.affiliation: Department of Human Ecology, University of Alberta, Edmonton, Canada.
authors.forename: Deanna L
authors.initials: DL
authors.lastname: Williamson
authors.affiliation: Faculty of Extension, University of Alberta, Edmonton, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Mayan
authors.affiliation: Faculty of Extension, University of Alberta, Edmonton, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Templeton
authors.affiliation: Department of Oncology, University of Alberta, Edmonton, Canada.
authors.forename: Konrad
authors.initials: K
authors.lastname: Fassbender
mesh_terms: D000328:Adult; D000416:Alberta; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005192:Family Health; D005260:Female; D000070497:Healthy Lifestyle; D006801:Humans; D008297:Male; D021661:Management Service Organizations / Q000706:statistics & numerical data; D011203:Poverty; D011320:Primary Health Care / Q000458:organization & administration*; D011998:Recreation; D012111:Residence Characteristics; D018401:Sample Size; D012947:Social Work / Q000458:organization & administration