In the series, we explore three different models of children and families’ services delivering interventions to tackle the root causes of child poverty. This third blog details how the ‘Healthier Wealthier Families’ (HWF) model was implemented in Sweden following its success in Australia.

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Sweden is known for its universal health services, accessible and affordable early education, and welfare benefits for parents with young children. It also has budget and debt-counselling services offered by municipalities, free of charge. These services are mandatory for municipalities to offer, but historically there has been low public awareness. In fact, despite our many years of work in the field as researchers, we had never even heard of the budget and debt-counselling system in Sweden until our colleagues in Australia, who were working with a model called Healthier Wealthier Families, got in touch. 

The idea seemed brilliant: take two universally available services and establish a connection so that families identified as at risk for financial hardship by the child health services could be referred to budget and debt counselling. We quickly discovered that although nurses at the child health services asked various personal and sensitive questions about children and family life, they were not used to addressing questions about finances. However, a study showed that the majority of nurses and parents considered it a positive thing to talk about finances at the child healthcare centre, which was seen as a safe space. With an established contact and an active referral to the budget and debt-counselling service, the nurses felt more confident in asking questions about finances. 

To support the budget and debt counsellors in shifting their work towards being more preventative, we co-designed a manual with counsellors, service managers, and parents with their own experience of living in economic hardship with young children. The process highlighted the need for flexibility in how the counsellors supported clients, as each client has different needs and tailored responses were welcomed from both sides.  

The end result was a dual-perspective visual guide which helps guide the conversation through topics known to be of importance to families facing economic hardship. On the client’s side, simple pictorial prompts are displayed and on the counsellor’s side, topics are accompanied by more detailed prompts on the types of support that can be offered.   

After a successful pilot, we received funding to conduct a randomised controlled trial targeting areas across Sweden with high rates of relative child poverty. The trial is ongoing and apart from the usual ‘trial hiccups', such as slow site recruitment, administrative challenges with legal agreements, and staff turnover, the need and uptake of the model are as we expected based on the numbers in our pilot study. That means that not all those who are eligible are interested, and not all those who are interested end up attending. However, those who do want to take part are usually motivated and follow through. 

Given the current cost-of-living crisis, budget and debt counsellors have been increasingly present in daily media coverage. Although a sign of increasing challenges for families with young children and low incomes, it has at least raised awareness of the services available for families.  Economic hardship can be connected to feelings of shame and taboo but in the aftermath of the COVID-19 pandemic and with the impending inflation, more people are experiencing difficulty in making ends meet. As more people raise their voices about the need for support, and budget and debt counsellors become more visible in everyday news, the awareness of the importance of preventative work like this increases.  

The challenge at this stage is not so much with the child health services, who have developed good routines for screening and referral, but the sustainability of budget and debt-counselling services providing preventative, rather than reactive services. Some of the services have a three to six month waiting list, which makes it very difficult for them to prioritise preventative work. The paradox is of course that preventative work is needed now more than ever – when resources are becoming even more constrained and families with limited income and no buffer require financial advice and support to make wise financial and budgeting decisions.  

If the trial proves to be successful, the Healthier Wealthier Families model could become a permanent fixture in the practice of Swedish child health services. As we await the results of the trial, let’s hope for a future where all children in Sweden, regardless of their family's economic circumstances, can enjoy a healthy and prosperous start in life. 

The other blogs in the series can be accessed here:

Working towards a Best Start and Bright Futures: reflections on an NHS child poverty partnership 

The power of working together: when health and financial wellbeing services join forces