Medical-legal partnerships effectively identify and treat patterns of substandard housing

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Key findings:

1. Medical and legal collaboration can lead to the recognition and address of social determinants of health, allowing for complete treatment high-risk patients.

Primer: Medical-legal partnership (MLP) is a model that was developed at Boston Medical Centre in 1993 and is now used at over 200 health centres across the United States. MLP enlists lawyers as part of the health care team to enforce regulations affecting the social determinants of individual and community health. Low-income families tend to have more than one unmet social need but addressing one social determinant of health can address other risk factors or connect families to further resources and agencies for support. Medical professionals can evaluate social risk in patients and legal advocates can help individuals and families access governmental programs (e.g. public benefit programs, income support, education services) or enforce laws. Many programs and regulations are in place to protect health but these may not be accessible to vulnerable populations or individuals may not have the power to challenge unlawful actions when acting alone. This study describes the use of a MLP to identify and treat a cluster of substandard housing through two pediatric clinics.

For further reading, please see the following studies:

1. Weintraub D, Rodgers MA, Botcheva L, et al. Pilot study of medical-legal partnership to address social and legal needs of patients. Journal of Health Care for the Poor and Underserved 2010;21:157-168.
2. Zuckerman B, Sandel M, Lawton E, Morton S. Medical-legal partnerships: transforming health care. The Lancet 2008;372:1615-1617.

This [case-control] study: In this case-control study, a case was defined as a rented housing unit where at least one patient less than 18 years of age lived and with at least one clinically relevant housing risk that was not being adequately addressed. Sixteen cases were identified from the outpatient population of two clinics at the Cincinnati Children’s Hospital Medical Center. Pest infestation was the most common housing risk identified and two or more risks were identified in 13 of the 16 cases. At least 45 children lived in the 16 housing units and this group was found to have a significantly higher prevalence of asthma, elevated blood lead levels, developmental delay or behavioral disorder than the general population of 22,200 children who receive care at the two clinics. The MLP, Cincinnati Child Health-Law Partnership (Child HeLP), found that all of the identified cases were located in building complexes owned and managed by a single developer. The partnership advocated for patients and helped form a tenant association, which led to repairs, relocations to safer apartments, and complex-wide systemic repairs.

In sum: Collaboration between the health care team, legal advocates, social workers and families allowed effective treatment of patients and improvements in housing conditions. Child HeLP was able to address multiple social determinants of health by connecting families to community resources and agencies such as public benefit programs and educational interventions. These results have limited generalizability since cases were drawn from a single institution and causation cannot be determined between housing conditions and disease, as the onset of symptoms was unknown. The study, however, shows that medical-legal partnerships can identify patterns in social risks and lead to their improvement.

Click to read the study in Pediatrics

By [AdC] and [AC]

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