Dr. Michael Hole: New Paper on Improving Child Health through Financial Interventions

June 7, 2018
Michael Hole StreetCred Pediatrics

The earned income tax credit (EITC) is a refundable tax credit benefit for working people with low to moderate income. The EITC reduces the amount of tax owed and may also allow a refund. Yet 20% of eligible hardworking families do not receive the much needed benefit.

Pediatrician Dr. Michael Hole, CHASP Faculty Fellow and joint faculty of the Dell Medical School and the LBJ School of Public Affairs at The University of Texas at Austin, co-founded StreetCred, a national non-profit organization seeking to improve the health and future of children growing up in poverty, after recognizing the lost opportunities, and money, his patients' parents experienced by not receiving all their tax benefits.

Many eligible familes have never even heard of the EITC and other anti-poverty government programs. StreetCred helps these families by providing free tax preparation and financial literacy services where parents already are waiting with their children -- in pediatric hospitals and clinics.

Dr. Hole and his colleagues published findings about the program in the new paper, Free Tax Services in Pediatric Clinics, in Pediatrics, the official journal of the American Academy of Pediatrics. See below for full abstract.

Dr. Hole, a first-generation college graduate, was a top student at Butler University before earning his MD and MBA from Stanford University with concentrations in public management, community health, and social innovation. He completed pediatrics residency at Harvard Medical School before joining The University of Texas. He was also named a Forbes Magazine “30 Under 30” social entrepreneur in 2016. More about Dr. Hole.


Free Tax Services in Pediatric Clinics

Pediatrics (May 2018)


OBJECTIVES: The earned income tax credit (EITC), refundable monies for America’s working poor, is associated with improved child health. Yet, 20% of eligible families do not receive it. We provided free tax preparation services in clinics serving low-income families and assessed use, financial impact, and accuracy.

METHODS: Free tax preparation services (“StreetCred”) were available at 4 clinics in Boston in 2016 and 2017. We surveyed a convenience sample of clients (n = 244) about experiences with StreetCred and previous tax services and of nonparticipants (n = 100; 69% response rate) and clinic staff (n = 41; 48% response rate) about acceptability and feasibility.

RESULTS: A total of 753 clients received $1 619 650 in federal tax refunds. StreetCred was associated with significant improvement in tax filing rates. Of surveyed clients, 21% were new filers, 47% were new users of free tax preparation, 14% reported new receipt of the EITC, and 21% reported new knowledge of the EITC. StreetCred had high client acceptability; 96% would use StreetCred again. Families with children were significantly more likely to report StreetCred made them feel more connected to their doctor (P = .02). Clinic staff viewed the program favorably (97% approval).

CONCLUSIONS: Free tax services in urban clinics are a promising, feasible financial intervention to increase tax filing and refunds, save fees, and link clients to the EITC. With future studies, we will assess scalability and measure impact on health. StreetCred offers an innovative approach to improving child health in primary care settings through a financial intervention.

Full article: Online, PDF