ASSIST: Refinement of a Benefits Navigator Intervention Among Low-Income Pediatric Oncology Families

Children with cancer living in poverty experience worse survival and quality of life. Interventions connecting low-income families to benefits (e.g., Supplemental Nutrition Assistance Program [SNAP] improve health outcomes; yet nearly 50% of SNAP-eligible pediatric oncology families are unenrolled. We developed ASSIST (Assisted Benefits Navigation Support) to connect pediatric oncology families to SNAP, the Special Supplemental Program for Women, Infants, and Children (WIC), and the Earned Income Tax Credit (EITC) via benefits navigation.

This was a single-center intervention pilot refinement study among 10 low-income families of children with newly diagnosed cancer directly assigned to ASSIST for 6 months. We evaluated refinement endpoints of intervention acceptability, delivery, and content based on descriptive analysis of parent surveys at study entry and 6 months, and thematic analysis of semi-structured interviews at 1, 3, and 6 months.

Ten families consented to participation (64% of approached) with 0% attrition over 6 months. ASSIST was acceptable to families; 9/10 participants completed benefits applications or renewals. No families utilized free tax preparation. The navigator spent an average of 6.5 h per participant across a median 9.5 encounters; participants were highly satisfied with intervention delivery. Despite benefits navigation, most (80%) reported unmet basic needs at study exit.

Opportunities to refine intervention content included: (1) a "bundled" approach of benefits navigation alongside short-term direct resource provision to address unmet needs and (2) modification of the EITC component to increase uptake. These findings will inform ASSIST optimization for a future dual-site pilot evaluation of the refined ASSIST.