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Background: Families with low incomes experience an array of health and social challenges that compromise their resilience and lead to negative family outcomes. Along with financial constraints, there are barriers associated with mental and physical health, poorer education and language. In addition, vulnerable populations experience many services as markedly unhelpful. This combination of family and service barriers results in reduced opportunities for effective, primary-level services and an increased use of more expensive secondary-level services (e.g., emergency room visits, child apprehensions, police involvement). A systematic review of effective interventions demonstrated that promotion of physical and mental health using existing service was critically important., Methods/design: The Families First Edmonton Trial (FFE) tests four service integration approaches to increase use of available health and social services for families with low-income. It is a randomized, two-factor, single-blind, longitudinal effectiveness trial where low-income families (1168) were randomly assigned to receive either (1) Family Healthy Lifestyle plus Family Recreation service integration (Comprehensive), (2) Family Healthy Lifestyle service integration, (3) Family Recreation service integration, or (4) existing services. To be eligible families needed to be receiving one of five government income assistance programs. The trial was conducted in the City of Edmonton between January 2006 and August 2011. The families were followed for a total of three years of which interventional services were received for between 18 and 24 months. The primary outcome is the number of family linkages to health and social services as measured by a customized survey tool "Family Services Inventory". Secondary outcomes include type and satisfaction with services, cost of services, family member health, and family functioning. Where possible, the measures for secondary outcomes were selected because of their standardization, the presence of published norming data, and their utility as comparators to other studies of low-income families. As an effectiveness trial, community and government partners participated in all committees through a mutually agreed upon governance model and helped manage and problem solve with researchers., Discussion: Modifications were made to the FFE trial based on the pragmatics of community-based trials., Trial Registration Number: ClinicalTrials.gov NCT00705328.

This article assesses the partnership functioning of Families First Edmonton, a multisectored collaborative effort formed to determine the best health and recreation service delivery model for families with low income. Partners' evaluations of the collaborative process are examined across the formation, implementation, and maintenance stages of development. Statistical analyses of questionnaire data reveal a significant decrease in the partnership's capacity to maximize synergy-a main indicator of a successful collaborative process-in the implementation stage of the partnership. Implications for partnership practice are addressed.

Working poverty in Canada is shrouded in mystery and misconception due to the little attention given to this area in research and policy-making. We performed an analysis of working poverty in Canada by using data from the Canadian Income Survey and conducted a binomial logistic regression to discuss the general profile of the working poor and the determinants of working poverty. We found that the working poor have high rates of post-secondary education and worked full-time hours. Moreover, being an immigrant, a single-earner (e.g., unattached individual, lone-parent family, single-earning household), and being self-employed were determinants of working poverty. [ABSTRACT FROM AUTHOR]

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Community engagement is central to a research process called integrated knowledge translation (IKT), which is characterized by the co-creation of knowledge among various partners. Families First Edmonton used an IKT partnership model to address poverty issues over a 15-year period. The purpose of this study is to describe barriers to the sustainability of this IKT partnership and how these were overcome. We generated interview data with 23 IKT partners who worked with or within municipal and provincial governments; we used qualitative description to frame our data and conventional qualitative content analysis for data analysis. Partners described the ways in which election cycles threatened the sustainability of the IKT partnership and posed barriers to their work. Three barriers were identified by partners: 1) narrowed windows of opportunity, 2) muddled directions and priorities, and 3) changed project partners. According to partners who collaborated across academic, government, and community settings, relationships offset these barriers through various mechanisms, including long-term relationship building, ongoing contact, and a recognition that while success may be subtle, resulting ripple effects can have important impacts over time. Relationships represent an important investment for partners who continue to work in narrow time frames imposed by election cycles. Partners indicated that relationships are a key strategy to ensuring sustainability of the IKT partnership and can have a farther-reaching impact than policy change. [ABSTRACT FROM AUTHOR]

Background: 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.Methods: 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.Results: 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).Conclusions: 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.Trial Registration: ClinicalTrials.gov, NCT00705328 . Registered on 24 June 2008. [ABSTRACT FROM AUTHOR]