Providing free tax preparation services in urban pediatric clinics can improve the rate of tax filing and tax refunds as well as improve access to earned income tax credit (EITC) among America’s working poor, according to a study in Pediatrics. Considering that refundable monies of EITC are associated with greater child health, free tax preparation services can have significant implications in pediatric care.

A sample of clients who used the StreetCred service — which offered free tax preparation services at 4 Boston clinics for families and individuals with taxable income — were assessed in the study. Investigators evaluated the acceptability, feasibility, and effectiveness of the service among 753 clients from 2016 to 2017. The group of clients was comprised of pediatric clinic families, other clinic-area patients, hospital employees, and unaffiliated taxpayers.

After the exclusion of participants who did not respond to the initial questionnaire, investigators surveyed a sample of participants who used StreetCred (n=244) to compare their levels of acceptability and feasibility of the service with those of nonparticipant clients (n=100) and clinic staff (n=41).

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As predicted, a significant increase was observed in the access to free tax preparation services among StreetCred participants compared with the prior tax year (100% vs 53%, respectively; P <.0001). Based on self-report, StreetCred was associated with a 21% significant improvement in tax filing compared with the previous year (100% vs 79%, respectively; P <.0001).

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In addition, there was a 21% improvement in the knowledge of EITC following StreetCred participation vs at baseline (58% vs 37%, respectively; P <.0001). There was also a significant increase the number of clients who received EITC after participating in the free tax service compared with clients who reported receiving it in the previous tax year (37% vs 23%, respectively; P <.0001), but these findings were considered nonsignificant after exclusion of participants who were unsure of their prior year’s EITC receipt status (P =.19).

No differences were found between clients with children vs clients without children in the feasibility of the free tax preparation service. Acceptability of the service was high among clients and clinic staff, with 96% of clients reporting they would use the service again. Clients with children were more likely to report feeling a greater connection to their doctor compared with clients without children (P =.02).

The use of convenience sampling as well as self-reported data likely limit the generalizability and accuracy of the findings, respectively.

”This intervention is scalable given the prevalence of catchment clinics, dedicated staff, and community-based Volunteer Income Tax Assistance organizations,” the researchers concluded.


Marcil LE, Hole MK, Wenren LM, Schuler MS, Zuckerman BS, Vinci RJ. Free tax services in pediatric clinics. Pediatrics. 2018;141(6).