Using medico-legal partnerships to strengthen children’s health

People who face utility shutdowns are also more likely to experience poor health, hospitalization, and concerns about their children’s development. And these tensions are getting worse as energy prices rise.

In a new study, Yale researchers sought to better understand what other stressors families experiencing energy insecurity face — and to substantiate the value of a model known as medico-legal partnerships to address them.

Most U.S. states have laws that protect people from shutting off utilities — such as water, sewer and electricity — when those services are deemed necessary to prevent life-threatening medical conditions, often requiring a certificate signed by a doctor. For the study, published Oct. 13 in the journal Pediatrics, researchers surveyed families with children who received such a certificate for other health-related social needs.

They found that most families surveyed also faced food, housing and financial insecurity. Most delinquent utility bills ranged from less than $500 to more than $20,000. Almost all said their utility discharge certificates were helpful.

Understanding how often these stressors co-occur, the researchers said, is key to ensuring they can be addressed. And medico-legal partnerships—which place legal services within health care settings and provide essential legal support to meet social health-related needs—can play a large role in this effort.

Study authors Julia Rosenberg, an assistant professor of pediatrics at Yale School of Medicine, and Alice Rosenthal, an attorney with the nonprofit law firm Children’s Advocacy Center and head of its medical legal partnership at Yale New Haven Hospital, sat down with Yale News. to discuss the challenge, benefit of medical-legal partnerships, and the importance of understanding societal health-related needs.

This interview has been edited and condensed.

What are medico-legal partnerships and what services do they provide?

Alice Rosenthal: The medical-legal partnership model fully incorporates legal services for low-income families into the medical facility. So the lawyer is part of the health clinic, and with that the providers, the nurses, the doctors, the social workers, everybody in the clinic thinks about legal health as part of health care. This makes them think and review the legal aspects that affect someone’s health and introduce patients to the attorney so they can address any legal issues.

How common are medico-legal partnerships?

Rosenthal: The patient is more likely to do so no have access to one at their healthcare facility. There are very few lawyers for low-income families in the country, and most civil legal matters go unaddressed. In the world of medico-legal partnership, it is very difficult to find funding to support a lawyer in a healthcare setting.

Why is it important to have a better understanding of social needs related to health?

Julia Rosenberg: I think that as health care providers, looking at health from a holistic perspective and understanding all the contextual factors that can affect health is extremely important. In pediatrics, we often focus on prevention. We have preventative visits where we are able to guide families and patients and advise them on all sorts of ways to help children thrive in the future. One of the most important ways to prepare children for success is to make sure that all aspects that affect health, including housing, food, electricity, equal access to education, are taken into account.

One of the benefits of embedding the Children’s Advocacy Center in our health facility is that when we see certain aspects of health-related social needs that may be affected by legal support, we now have a solution available. It is through this ongoing collaboration that we begin to learn how to identify these needs more acutely and can intervene.

What did your new study reveal about the stress these families face?

Rosenberg: We looked at families who received protection from utility shutdowns through our medical-legal partnership and found that most had co-occurring health-related social needs related to housing insecurity, food insecurity, and financial insecurity.

The percentage of families experiencing this uncertainty is higher than previous studies of adults have found. Why do you think that was the case?

Rosenberg: We only have hypotheses at this point, but one thought is that when there are stressors, there is a greater impact on families with children. We have seen this trend in other situations, such as the COVID-19 pandemic, for example.

Rosenthal: Families with children are particularly vulnerable to these types of stressors due to the high cost of raising children. The pandemic has exposed this for all of us to see. Also, as Dr. Rosenberg pointed out, pediatricians do a lot of preventative medicine and work with families to identify stressors and alleviate them before they become real problems. This type of preventive care may not always happen in adults.

What do you hope people take away from these findings?

Rosenberg: We have shown that there are health-related social needs that occur at relatively high levels – addressing them is very important. Another important takeaway is the value of interdisciplinary initiatives such as medical-legal partnerships. When we are able to meet one of a family’s needs—whether it’s medical, mental health, or social health needs—we have that opportunity to provide holistic care and address other needs. And we can do this in a medical facility that has a medical-legal partnership.

Rosenthal: Many families we work with are skeptical about why they would tell their child’s pediatrician about their housing or food insecurity. But when we train providers to think about the social determinants of health as part of health care, families feel more comfortable sharing that information, and therefore their children are healthier.

So I would say that everyone should have a medical-legal partnership or an interdisciplinary, holistic way of providing care, so that even if you don’t have an attorney in the clinic, providers know what community resources are available to patients and their families.

Leave a Comment

Your email address will not be published. Required fields are marked *