System fragmentation and service silos: Leveraging provider perspectives to support families living in poverty
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Temple University College of Public Health 28 Wilson Ave Chalfont PA 18914 USA United States
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1152
Background and significance:
Intersections of high poverty and trauma increase risks for toxic stress, which can have major consequences for health and mental health. These consequences are particularly salient during childhood, when physical growth and brain development undergo rapid change. Service providers are often the first and only point of contact for many families and have invaluable perspectives on child health and wellbeing and community-driven factors that contribute to health equity or health disparities. Understanding perspectives of professionals involved in community support services could provide insight on system-level changes needed to promote child health equity and provide up-to-date information on the social, economic, and political circumstances promoting or impairing equitable and health and wellbeing among families with limited economic resources living in economically marginalized communities.

The aims of this qualitative study were to draw on the perspectives of multidisciplinary social service community professionals who work with populations exposed to high levels of systemic trauma and poverty. We apply a social justice and ecocultural lens to assess service provider perceptions of major barriers and facilitators to health and mental health in at-risk communities.

We conducted semi-structured in-depth interviews with _n_ = 21 social service staff, stakeholders, and volunteers. Service providers were asked a series of open-ended questions related to their perspectives on: (1) health disparities and their repercussions on family’s high risk for health disparities; and (2) protectors of and approaches to advance health equity. Analysis was conducted using MAX QDA analytic software, using an ongoing, iterative process following a systematic approach recommended for health research and capturing multi-layered, eco-cultural perspectives.

Major qualitative themes contributing to _health disparities_ included burnout and high turnover rates, complex family needs beyond organizational capacity, funding limitations, limited professional development, disconnects between family needs and services, and system fragmentation. Protectors of _health equity_ included prioritizing community engagement, partnerships with other providers, holistic and wrap-around physical and mental health supports, honoring choice and autonomy of families served, capacity building, and providing supports to address effects of vicarious trauma.

Implications are provided for organizational-level targets to promote child health equity in economically underserved populations.

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