Going beyond participation: community-led design and evaluation of the Philly Joy Bank

Introduction: In Philadelphia there are racial disparities in health outcomes during the perinatal period, such that Black infants and their parents experience a disproportionately higher burden of poor outcomes compared to their White counterparts. These excess risks are driven at least in part by high rates of poverty and other manifestations of structural racism. The provision of guaranteed income (GI) or unconditional cash payments during and after pregnancy, is a bold and evidence-based approach to advancing equity in financial security and health. The objective of this protocol paper is to describe the community-centered approach to the design of (a) the Philly Joy Bank (PJB), a perinatal GI program in Philadelphia, and (b) the evaluation of PJB's impact. Methods: PJB was conceived by an established coalition of community partners through a collective impact model. Decisions related to the design and implementation of PJB are made through a consensus building process that centers the voices of Lived Experience Experts (i.e., Black birthing people in Philadelphia). Congruent with the community-driven design of PJB, the evaluation of the impact of PJB is grounded in the principles of community-based participatory research and is co-designed by the community. Results: GI affects ability to meet basic needs and parental stress (Aim 2); and to explore the impact of PJB on parental mental health and the preliminary impact on infant prematurity (low birthweight and preterm birth) (Aim 3). Descriptive statistics, mixed effects regression analyses, and participatory qualitative analysis approaches will be used to achieve study aims. Discussion: GI is a promising upstream structural intervention to address persistent health inequities during the perinatal period: a critical period of the life course. Understanding if and how GI improves health for birthing people and their infants can inform implementation and policy to advance health equity.