Reducing Poverty, Improving Health

As Bob Vinci, MD, chairman of the Department of Pediatrics at Boston Medical Center, once said: “When we don’t have a service, we build it, so the next group of patients can access it.” This was never more true than when two pediatric residents, Lucy Marcil, MD, MPH, and Michael Hole, MD, MBA, came together to address the financial burden a significant portion of BMC patients face from living with annual incomes below the federal poverty level, often struggling to make ends meet. The result of their efforts was the creation of StreetCred—an innovative BMC program offering free tax services to families receiving pediatric care at BMC.

The service targets low-income, working families raising children in America, who are eligible to receive the Earned Income Tax Credit (EITC) and Child Tax Credit. Marcil and Hole saw a need for assisting these families, who were getting lost in a complicated system and, as a result, not receiving the tax benefits they were entitled. By helping these families receive appropriate tax credits and their full tax refunds, the pediatrics team is improving the overall well-being of the family’s health through poverty reduction.

“Just like we wouldn’t fail to give vaccines to children, we also can’t fail to help poor families get these valuable tax credits,” explains Hole. “Not only have they earned them, we also know these tax credits improve infant and maternal health as well as long-term educational and financial outcomes for children. Failing to make sure our families get this money is failing to give our pediatric patients the best shot in life.”

Decreasing the prevalence of poverty—a condition affecting more than 20% of American children—is a challenging obstacle. One effective poverty-alleviation tool is the EITC, a federal tax credit for the working poor. Receipt of the EITC has been associated with improved infant and maternal health. Unfortunately, almost a quarter of those eligible for this refund do not receive it. Therefore, StreetCred’s providers have made it their mission to address this gap, and help families receive vital financial assistance—necessary aid that can determine whether a family of five affords their one-bedroom apartment or not.

 “Our typical client was a single mother raising multiple children on under $10,000 a year. Just think for a moment how difficult that would be in Boston. They told us that with that extra $2,000, the average amount returned, they could buy fruits and vegetables, warm winter coats, high chairs—things that really are necessities for a healthy childhood, but are luxuries for our families.” – Lucy Marcil, MD, MPH, pediatric resident

In its pilot year, with the help of BMC staff and volunteers who serve as tax experts, StreetCred filed tax returns for 186 families, which resulted in a total return of $401,275 of which $96,209 was from the EITC. By leveraging this critical tax credit, families and their children have more financial stability, higher participation in their pediatric care and lower toxic stress.

“We’re beyond excited about StreetCred’s momentum. We’re scaling to three new sites around Boston for the 2017 tax season and expanding services to both Family Medicine and OB/GYN clinics at BMC,” says Marcil and Hole. “We’re motivated, too, by the realization we can expand services beyond tax preparation. Since we collect so much data from families, we think we could easily help them simultaneously apply for other evidence-based services like SNAP, Head Start, TANF, housing subsidies, and so on. It takes a lot to raise healthy children, especially in urban America, so we’re dedicated to ensuring our families have all the tools and resources they need to do so before they leave the doctor’s office.”

“StreetCred is a wonderful program because it brings financial resources to where they are most needed; into the hands of our families. Lucy and Mike have demonstrated amazing creativity and overcome a number of barriers to bring this program to fruition,” concludes Vinci. “Their dedication to our families and for building a program to address poverty is a perfect example of the work of the Department of Pediatrics. We are proud to have this program begin at BMC and appreciate the support of the entire BMC organization. Improving child health is our most important responsibility and what makes us most proud is knowing that StreetCred is making a difference in the lives of our patients. This is why we all work at BMC!”